Provider Demographics
NPI:1134478217
Name:CHOMICKI, WALTER R (DPT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:R
Last Name:CHOMICKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176-60 UNION TURNPIKE SUITE 195
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1538
Mailing Address - Country:US
Mailing Address - Phone:718-820-9300
Mailing Address - Fax:718-820-9382
Practice Address - Street 1:176-60 UNION TURNPIKE SUITE 195
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1538
Practice Address - Country:US
Practice Address - Phone:718-820-9300
Practice Address - Fax:718-820-9382
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035235-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist