MEDICARE: JULIE WALSH

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	15761	FL

General Provider Information

NPI Number	:	1982153219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE WALSH

Provider Business Mailing Address
First Line	:	3408 SANTA ROSA DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3408 SANTA ROSA DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5665
Country	:	US
Telephone Number	:	850-416-4678
Fax Number	:

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

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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