Provider Demographics
NPI:1861788069
Name:WALUKIEWICZ, PETER JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:WALUKIEWICZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1012
Mailing Address - Country:US
Mailing Address - Phone:201-572-4599
Mailing Address - Fax:
Practice Address - Street 1:7 HILLVIEW TER
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2304
Practice Address - Country:US
Practice Address - Phone:201-572-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer