Healthcare Provider Details

I. General information

NPI: 1003046251
Provider Name (Legal Business Name): NANCY J WALSH P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 197TH PL
CHICAGO HEIGHTS IL
60411-7539
US

IV. Provider business mailing address

3403 W OAKHILL DR
CRETE IL
60417-1965
US

V. Phone/Fax

Practice location:
  • Phone: 708-755-3020
  • Fax:
Mailing address:
  • Phone: 708-534-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070011814
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: