Provider Demographics
NPI:1508866906
Name:WALSH, MARK THOMAS (PT, DPT, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:WALSH
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1776
Mailing Address - Country:US
Mailing Address - Phone:609-927-5463
Mailing Address - Fax:609-927-3724
Practice Address - Street 1:24 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1776
Practice Address - Country:US
Practice Address - Phone:609-927-5463
Practice Address - Fax:609-927-3724
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA004739002251H1200X, 225100000X
PAPT000539E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA038916Medicare UPIN
NJ487334Medicare PIN