Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 00558 | OH |
NPI | 1003154717 |
---|---|
Provider Name | Mrs. Denise M Walch |
First Address | Tallmadge, OH 44278-2621 |
Second Address | Tallmadge, OH 44278-2235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2013 |
Last Update Date | 30/01/2013 |