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General NPI Number Information
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NPI Number | 1003571068
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Entity Type | Individual
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Provider Name | NICOLE LORD WALSH PTA
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Gender | Female
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1800 LOMBARD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1414
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Country | US
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Telephone | 215-893-6324
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Fax |
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Provider Business Mailing Address
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Address Line | 404 GALWAY CT
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City | MIDDLETOWN
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State | DE
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Zip | 19709-8796
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Country | US
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Telephone | 484-557-9550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TE011620
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License Number State | PA
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