Provider Demographics
NPI:1518988856
Name:WALUSZ, HOLLIE JANINE (MA, ATC, LAT, PES)
Entity Type:Individual
Prefix:MISS
First Name:HOLLIE
Middle Name:JANINE
Last Name:WALUSZ
Suffix:
Gender:F
Credentials:MA, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 STOCKLEY LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-6018
Mailing Address - Country:US
Mailing Address - Phone:757-206-4152
Mailing Address - Fax:
Practice Address - Street 1:1426 MARSHALLTON THORNDALE RD
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3673
Practice Address - Country:US
Practice Address - Phone:757-206-4152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer