Basic Information
| Provider Information | |||||||||
| NPI: | 1225532948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | L.M.T., L.P.T.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 MEETING HOUSE RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023642174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815850929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 LONG POND RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023602662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817602385 | ||||||||
| FaxNumber: | 5089274242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2018 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 13456 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.