Provider Demographics
NPI:1083958417
Name:WALSH, SARA-LOUISE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SARA-LOUISE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SHENIPSIT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2332
Mailing Address - Country:US
Mailing Address - Phone:860-872-2999
Mailing Address - Fax:
Practice Address - Street 1:26 SHENIPSIT LAKE RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2332
Practice Address - Country:US
Practice Address - Phone:860-872-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist