Provider Demographics
NPI:1356960264
Name:WALSH, ROBERT (MBA, LMT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:MBA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-0124
Mailing Address - Country:US
Mailing Address - Phone:617-500-6769
Mailing Address - Fax:
Practice Address - Street 1:275 HIGH STREET
Practice Address - Street 2:1ST FLOOR REAR
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:617-500-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist