Provider Demographics
NPI:1790997591
Name:KENDERSKI, WALTER J (MS,ATC)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:J
Last Name:KENDERSKI
Suffix:
Gender:M
Credentials:MS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5597 SANTIAGO DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4327
Mailing Address - Country:US
Mailing Address - Phone:614-891-0265
Mailing Address - Fax:
Practice Address - Street 1:323 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4753
Practice Address - Country:US
Practice Address - Phone:614-461-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0017692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer