Basic Information
| Provider Information | |||||||||
| NPI: | 1881612588 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKERWICZ | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 FLEMING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287913528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286980017 | ||||||||
| FaxNumber: | 8286929450 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 FLEMING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287913528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286980017 | ||||||||
| FaxNumber: | 8286929450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9837 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 841139 | 01 | NC | UHC ACN MPN | OTHER | 8277714 | 01 | NC | UHC ACN MPN | OTHER | 079KA | 01 | NC | BCBS | OTHER | 6606556 | 01 | NC | GHI | OTHER |