Provider Demographics
NPI:1811779754
Name:WALSH, RITA (DPT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9915 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7902
Mailing Address - Country:US
Mailing Address - Phone:708-925-8048
Mailing Address - Fax:
Practice Address - Street 1:845 N MICHIGAN AVE STE 973W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2218
Practice Address - Country:US
Practice Address - Phone:312-651-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist