MEDICARE: ALYSSA WALSH PT,DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	070023246	IL

General Provider Information

NPI Number	:	1083392641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA WALSH PT,DPT

Provider Business Mailing Address
First Line	:	1026 OGDEN AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 OGDEN AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2812
Country	:	US
Telephone Number	:	630-856-7600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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