Provider Demographics
NPI:1699022616
Name:WALSH, DANIEL (PT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:WEWAHITCHKA
Mailing Address - State:FL
Mailing Address - Zip Code:32465-8663
Mailing Address - Country:US
Mailing Address - Phone:850-639-2067
Mailing Address - Fax:
Practice Address - Street 1:232 WAGON TRL
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-8663
Practice Address - Country:US
Practice Address - Phone:850-639-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13363261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy