Provider Demographics
NPI:1093889495
Name:WALSH, ROBERT FRANCIS (MPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANCIS
Last Name:WALSH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2222 FOOTHILL BLVD
Mailing Address - Street 2:E-553
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1456
Mailing Address - Country:US
Mailing Address - Phone:818-749-5056
Mailing Address - Fax:818-920-9473
Practice Address - Street 1:14427 CHASE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3020
Practice Address - Country:US
Practice Address - Phone:818-920-9474
Practice Address - Fax:818-920-9473
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT21051Medicare PIN