Provider Demographics
NPI:1588717730
Name:WALESZONIA, JOSEPH ANTHONY (MSPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:WALESZONIA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7432
Mailing Address - Country:US
Mailing Address - Phone:870-203-9988
Mailing Address - Fax:870-203-9986
Practice Address - Street 1:3005 APACHE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7432
Practice Address - Country:US
Practice Address - Phone:870-203-9988
Practice Address - Fax:870-203-9986
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist