Healthcare Provider Details

I. General information

NPI: 1437843828
Provider Name (Legal Business Name): CAITLYN WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 03/06/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 BROADWAY AVE N STE 110
ROCHESTER MN
55906-4159
US

IV. Provider business mailing address

PO BOX 7197
ROCHESTER MN
55903-7197
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax: 507-322-3450
Mailing address:
  • Phone: 507-322-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5056
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13164
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: