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NPI Code Detail

MEDICARE: MICHAEL WALSH DPT, ATC

MEDICARE: MICHAEL WALSH DPT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer
2390200000XStudent in an Organized Health Care Education/Training Program
3225100000XPhysical Therapist12299MN

General Provider Information

NPI Number : 1114468691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WALSH DPT, ATC
Provider Business Mailing Address
First Line : 116 BROWNSVILLE ST NE
Second Line :
City : PRESTON
State : MN
Zip : 55965-1127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4229 W FRONTAGE RD N
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-4310
Country : US
Telephone Number : 507-322-3460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2017
Last Update Date : 12/18/2024

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