Provider Demographics
NPI:1043462708
Name:WALSH, PRISCILLA NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:NICOLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1459
Mailing Address - Country:US
Mailing Address - Phone:239-574-8922
Mailing Address - Fax:239-573-7356
Practice Address - Street 1:4075 PINE RIDGE RD EXT
Practice Address - Street 2:UNIT # 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-4005
Practice Address - Country:US
Practice Address - Phone:239-368-8606
Practice Address - Fax:239-368-8608
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist