Provider Demographics
NPI:1720141450
Name:WALSH, JOLENE (PT, MPT)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3004
Mailing Address - Country:US
Mailing Address - Phone:703-599-0634
Mailing Address - Fax:
Practice Address - Street 1:2212 MOUNT VERNON AVE
Practice Address - Street 2:CORE WELLNESS AND PHYSICAL THERAPY
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1356
Practice Address - Country:US
Practice Address - Phone:703-599-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206757225100000X
MD20693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist