Most Relevant Information
Provider Data
| NPI Number: | 1003571068 |
| Provider Name: | NICOLE LORD WALSH PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | TE011620 |
Most Important Dates
| Enumeration Date: | 11/04/2021 |
| Last Updated: | 11/04/2021 |
Provider Practice Location
1800 LOMBARD ST
PHILADELPHIA
PA
191461414
Practice Location Phone/Fax
| Phone: | 2158936324 |
| Fax: |
Provider Mailing Location
404 GALWAY CT
MIDDLETOWN
DE
197098796
Provider Mailing Phone/Fax
| Phone: | 4845579550 |
| Fax: |