Provider Demographics
NPI:1174572507
Name:WALSH, MICHAEL J (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WALSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 COUNTY LINE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1720
Mailing Address - Country:US
Mailing Address - Phone:215-360-7824
Mailing Address - Fax:215-357-8499
Practice Address - Street 1:1810 COUNTY LINE ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-360-7824
Practice Address - Fax:215-501-5108
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016879L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093372Medicare PIN