Provider Demographics
NPI:1760265854
Name:WILCZYNSKI, WALTER TREVOR (DPT)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:TREVOR
Last Name:WILCZYNSKI
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 1:8861 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:JEDDO
Mailing Address - State:MI
Mailing Address - Zip Code:48032-8206
Mailing Address - Country:US
Mailing Address - Phone:810-335-5366
Mailing Address - Fax:
Practice Address - Street 1:8861 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:JEDDO
Practice Address - State:MI
Practice Address - Zip Code:48032-8206
Practice Address - Country:US
Practice Address - Phone:810-335-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist