Provider Demographics
NPI:1215062443
Name:WALSH, KATHERINE I (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:I
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 COUNTY ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13076-3180
Mailing Address - Country:US
Mailing Address - Phone:315-676-4498
Mailing Address - Fax:
Practice Address - Street 1:149 COUNTY ROUTE 38
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NY
Practice Address - Zip Code:13076-3180
Practice Address - Country:US
Practice Address - Phone:315-676-4498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015060-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist