Provider Demographics
NPI:1053641456
Name:WALSH, JENIFER
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7524 GIBRALTAR ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7409
Mailing Address - Country:US
Mailing Address - Phone:805-795-4102
Mailing Address - Fax:
Practice Address - Street 1:7524 GIBRALTAR ST
Practice Address - Street 2:UNIT C
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7409
Practice Address - Country:US
Practice Address - Phone:805-795-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic