Healthcare Provider Details

I. General information

NPI: 1023594876
Provider Name (Legal Business Name): CHRISTY J WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24726 75TH ST
SALEM WI
53168-9704
US

IV. Provider business mailing address

1300 S GREEN BAY RD STE 205
MOUNT PLEASANT WI
53406-4469
US

V. Phone/Fax

Practice location:
  • Phone: 262-843-8333
  • Fax: 262-843-2948
Mailing address:
  • Phone: 262-898-3930
  • Fax: 262-898-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number640-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: