Provider Demographics
NPI:1134596182
Name:MICHALUK, ERIC CONNELLY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CONNELLY
Last Name:MICHALUK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 CHERRY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2923
Mailing Address - Country:US
Mailing Address - Phone:240-281-3718
Mailing Address - Fax:
Practice Address - Street 1:4220 CHERRY VALLEY DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2923
Practice Address - Country:US
Practice Address - Phone:240-281-3718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25629225100000X
FL31323225100000X
WAPT60592029225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist