Provider Demographics
NPI:1023384757
Name:MURPHY, EILEEN E WALSH (PT)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:E WALSH
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:ELIZABETH
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24 NUTLY PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2908
Mailing Address - Country:US
Mailing Address - Phone:718-815-8973
Mailing Address - Fax:
Practice Address - Street 1:24 NUTLY PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2908
Practice Address - Country:US
Practice Address - Phone:718-815-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist