Provider Demographics
NPI:1497749634
Name:WALSH, KERRY LYNNE (PT)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:LYNNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-0000
Mailing Address - Country:US
Mailing Address - Phone:508-966-2717
Mailing Address - Fax:508-966-2095
Practice Address - Street 1:40 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-0000
Practice Address - Country:US
Practice Address - Phone:508-966-2717
Practice Address - Fax:508-966-2095
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00000978225100000X
MA19240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist