Provider Demographics
NPI:1477942621
Name:WALSH, TERESA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8727
Mailing Address - Country:US
Mailing Address - Phone:910-215-0541
Mailing Address - Fax:910-215-9886
Practice Address - Street 1:211 CENTRAL PARK AVE
Practice Address - Street 2:SUITE L
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8727
Practice Address - Country:US
Practice Address - Phone:910-215-0541
Practice Address - Fax:910-215-9886
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist