Healthcare Provider Details

I. General information

NPI: 1497749634
Provider Name (Legal Business Name): KERRY LYNNE WALSH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NORTH MAIN STREET
BELLINGHAM MA
02019-0000
US

IV. Provider business mailing address

40 NORTH MAIN STREET
BELLINGHAM MA
02019-0000
US

V. Phone/Fax

Practice location:
  • Phone: 508-966-2717
  • Fax: 508-966-2095
Mailing address:
  • Phone: 508-966-2717
  • Fax: 508-966-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00000978
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: