Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PTH3066 | AL |
NPI | 1063408961 |
---|---|
Provider Name | Mr. David Allen Walsh |
First Address | Auburn, AL 36849-0001 |
Second Address | Auburn, AL 36849-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTH3066 | PHYSCIAL THERAPIST LICENS (01) | AL |