Healthcare Provider Details

I. General information

NPI: 1396923926
Provider Name (Legal Business Name): HEATHER WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 BEVILLE RD
SOUTH DAYTONA FL
32119-1951
US

IV. Provider business mailing address

619 E FRANKFORD ST
BETHLEHEM PA
18018-3126
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-4395
  • Fax: 866-426-2811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE007690
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: