MEDICARE: JOLENE WALSH PT, MPT

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
1	225100000X	Physical Therapist	2305206757	VA
2	225100000X	Physical Therapist	20693	MD

General Provider Information

NPI Number	:	1720141450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLENE WALSH PT, MPT

Provider Business Mailing Address
First Line	:	1200 N QUAKER LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-3004
Country	:	US
Telephone Number	:	703-599-0634
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 MOUNT VERNON AVE
Second Line	:	CORE WELLNESS AND PHYSICAL THERAPY
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1356
Country	:	US
Telephone Number	:	703-599-0634
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	12/10/2012

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