Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 070011814 | IL |
NPI | 1003046251 |
---|---|
Provider Name | Ms. Nancy J Walsh |
First Address | Crete, IL 60417-1965 |
Second Address | Chicago Heights, IL 60411-7539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2009 |
Last Update Date | 22/07/2009 |