Provider Demographics
NPI:1104020437
Name:WALSH, TIMOTHY (PT, MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-8529
Mailing Address - Country:US
Mailing Address - Phone:419-996-9650
Mailing Address - Fax:888-881-8547
Practice Address - Street 1:4825 SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-8529
Practice Address - Country:US
Practice Address - Phone:419-996-9650
Practice Address - Fax:888-881-8547
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.002445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist