Provider Demographics
NPI:1508415001
Name:WALSH, COLLEEN MAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MAE
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 1:23 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1809
Mailing Address - Country:US
Mailing Address - Phone:631-495-6908
Mailing Address - Fax:
Practice Address - Street 1:5006 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4514
Practice Address - Country:US
Practice Address - Phone:631-416-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports