Basic Information
Provider Information
NPI: 1033557129
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALSH
FirstName: CATHERINE
MiddleName: AMY
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 522 AMHERST ST
Address2: STE 22
City: NASHUA
State: NH
PostalCode: 030631019
CountryCode: US
TelephoneNumber: 6038800448
FaxNumber: 6038815280
Practice Location
Address1: 522 AMHERST ST
Address2: STE 22
City: NASHUA
State: NH
PostalCode: 030631019
CountryCode: US
TelephoneNumber: 6038800448
FaxNumber: 6038815280
Other Information
ProviderEnumerationDate: 06/11/2013
LastUpdateDate: 06/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X3762NHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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