Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1508415001 |
---|---|
Provider Name | Dr. Colleen Mae Walsh |
First Address | East Islip, NY 11730-1809 |
Second Address | Holbrook, NY 11741-4514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 06/09/2019 |