Provider Demographics
NPI:1962181248
Name:WALSH, SARA MICHAEL (PT)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MICHAEL
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 1:7204 SW DURHAM ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7574
Mailing Address - Country:US
Mailing Address - Phone:503-941-9869
Mailing Address - Fax:503-352-5555
Practice Address - Street 1:7204 SW DURHAM ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7574
Practice Address - Country:US
Practice Address - Phone:503-941-9869
Practice Address - Fax:503-352-5555
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist