MEDICARE: MS. KERRY LYNNE WALSH PT

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	225100000X	Physical Therapist	00000978	ME
2	225100000X	Physical Therapist	19240	MA

General Provider Information

NPI Number	:	1497749634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRY LYNNE WALSH PT

Provider Business Mailing Address
First Line	:	40 NORTH MAIN STREET
Second Line	:
City	:	BELLINGHAM
State	:	MA
Zip	:	02019-0000
Country	:	US
Telephone Number	:	508-966-2717
Fax Number	:	508-966-2095

Provider Business Practice Location Address
First Line	:	40 NORTH MAIN STREET
Second Line	:
City	:	BELLINGHAM
State	:	MA
Zip	:	02019-0000
Country	:	US
Telephone Number	:	508-966-2717
Fax Number	:	508-966-2095

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	09/29/2010

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