Healthcare Provider Details

I. General information

NPI: 1508193608
Provider Name (Legal Business Name): MIKE WALSH PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 NEW BURTON RD SUITE 2
DOVER DE
19904-5488
US

IV. Provider business mailing address

810 NEW BURTON RD SUITE 2
DOVER DE
19904-5488
US

V. Phone/Fax

Practice location:
  • Phone: 302-724-5593
  • Fax:
Mailing address:
  • Phone: 302-724-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberJ1-0001730
License Number StateDE

VIII. Authorized Official

Name: MR. MICHAEL WALSH
Title or Position: OWNER
Credential: PT
Phone: 302-724-5593