Provider Demographics
NPI:1427383611
Name:WALSH, CHRISTINA SMITH
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SMITH
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 1:5606 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5111
Mailing Address - Country:US
Mailing Address - Phone:504-733-0254
Mailing Address - Fax:504-734-8869
Practice Address - Street 1:839 SPAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-7824
Practice Address - Country:US
Practice Address - Phone:504-943-8826
Practice Address - Fax:504-943-8876
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B311CS35Medicare PIN