Healthcare Provider Details

I. General information

NPI: 1912214636
Provider Name (Legal Business Name): BEVERLY APPL WALSH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 JERMOR LN SUITE 102
WESTMINSTER MD
21157-6151
US

IV. Provider business mailing address

1609 N COALTER ST SUITE 102
STAUNTON VA
24401-2552
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-8076
  • Fax: 410-876-3818
Mailing address:
  • Phone: 540-213-1320
  • Fax: 540-213-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294690
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23375
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: