Provider Demographics
NPI:1740242551
Name:WALSH, DIANE ELIZABETH (PT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:STE 1402
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4404
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:2902 ROUTE 130
Practice Address - Street 2:TENBY PLAZA
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2525
Practice Address - Country:US
Practice Address - Phone:856-461-8331
Practice Address - Fax:856-461-9099
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2016-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00089700171100000X
NJ40QA00573900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist