Provider Demographics
NPI:1932599941
Name:WALSH, MARY BETH LADD (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARY BETH
Middle Name:LADD
Last Name:WALSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FELSDALE CLOSE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3166
Mailing Address - Country:US
Mailing Address - Phone:781-756-8055
Mailing Address - Fax:
Practice Address - Street 1:8 FELSDALE CLOSE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-3166
Practice Address - Country:US
Practice Address - Phone:781-756-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist