Basic Information
| Provider Information | |||||||||
| NPI: | 1467963215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DIDIER | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8201 ATLEE RD STE D | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231161815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045691787 | ||||||||
| FaxNumber: | 8045699787 | ||||||||
| Practice Location | |||||||||
| Address1: | 4101 COX RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047160457 | ||||||||
| FaxNumber: | 8047160496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2017 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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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 | 225100000X | 2305211205 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.