Provider Demographics
NPI:1508193608
Name:MIKE WALSH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MIKE WALSH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:302-724-5593
Mailing Address - Street 1:810 NEW BURTON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5488
Mailing Address - Country:US
Mailing Address - Phone:302-724-5593
Mailing Address - Fax:
Practice Address - Street 1:810 NEW BURTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-5488
Practice Address - Country:US
Practice Address - Phone:302-724-5593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001730261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy