Provider Demographics
NPI:1588609945
Name:PELENSKI, WALTER ANTHONY III (OT,PT,CHT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ANTHONY
Last Name:PELENSKI
Suffix:III
Gender:M
Credentials:OT,PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STOCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3332
Mailing Address - Country:US
Mailing Address - Phone:732-513-0795
Mailing Address - Fax:
Practice Address - Street 1:1200 EAGLE AVE
Practice Address - Street 2:
Practice Address - City:OCEAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07712-1265
Practice Address - Country:US
Practice Address - Phone:732-660-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00028300225X00000X
NJ40QA01142800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist