Provider Demographics
NPI:1962599258
Name:WALSH, MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 S STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5140
Mailing Address - Country:US
Mailing Address - Phone:302-632-9180
Mailing Address - Fax:
Practice Address - Street 1:1675 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5140
Practice Address - Country:US
Practice Address - Phone:302-632-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100017302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic