Provider Demographics
NPI:1306171095
Name:WALSH, KERRY LYNN (PT, MS)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W VETERANS HWY STE 12
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3435
Mailing Address - Country:US
Mailing Address - Phone:732-761-8400
Mailing Address - Fax:732-761-8401
Practice Address - Street 1:100 W VETERANS HWY STE 12
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3435
Practice Address - Country:US
Practice Address - Phone:732-761-8400
Practice Address - Fax:732-761-8401
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006535002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics