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NPI Code Detail

MEDICARE: JASON P WALSH DPT

MEDICARE:   JASON P WALSH  DPT
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
1225100000XPhysical Therapist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01055750OTHERILMEDICARE RAILROAD

General Provider Information

NPI Number : 1629309521
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON P WALSH DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number :
Provider Business Practice Location Address
First Line : 8019 DIXIE HWY STE 106
Second Line :
City : LOUISVILLE
State : KY
Zip : 40258-1303
Country : US
Telephone Number : 502-500-6970
Fax Number : 502-200-6973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2010
Last Update Date : 03/17/2018

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Directions to “ JASON P WALSH DPT” Practice Location

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