Provider Demographics
NPI:1912424748
Name:WALSH, SEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W GRAND CENTRAL AVE UNIT 819
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1980
Mailing Address - Country:US
Mailing Address - Phone:813-252-1054
Mailing Address - Fax:
Practice Address - Street 1:504 W GRAND CENTRAL AVE UNIT 819
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1980
Practice Address - Country:US
Practice Address - Phone:813-252-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11592225100000X
FLPT35792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist