Provider Demographics
NPI:1770967366
Name:PALUCHNIAK, MATTHEW (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:PALUCHNIAK
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 1:1139 S SUNNYSLOPE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3998
Mailing Address - Country:US
Mailing Address - Phone:262-321-0240
Mailing Address - Fax:
Practice Address - Street 1:1139 S SUNNYSLOPE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3998
Practice Address - Country:US
Practice Address - Phone:262-321-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13042-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist