Healthcare Provider Details

I. General information

NPI: 1699022616
Provider Name (Legal Business Name): DANIEL WALSH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 WAGON TRL
WEWAHITCHKA FL
32465-8663
US

IV. Provider business mailing address

232 WAGON TRL
WEWAHITCHKA FL
32465-8663
US

V. Phone/Fax

Practice location:
  • Phone: 850-639-2067
  • Fax:
Mailing address:
  • Phone: 850-639-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT13363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: