Healthcare Provider Details

I. General information

NPI: 1962599258
Provider Name (Legal Business Name): MICHAEL WALSH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 302-724-5593
  • Fax: 302-724-5595
Mailing address:
  • Phone: 302-724-5593
  • Fax: 302-724-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ10001730
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: