Provider Demographics
NPI:1932643665
Name:WALUKONIS, ANTHONY R (PT, DPT, MA, ATC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:WALUKONIS
Suffix:
Gender:M
Credentials:PT, DPT, MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 GRANNY WHITE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2908
Mailing Address - Country:US
Mailing Address - Phone:231-286-4210
Mailing Address - Fax:
Practice Address - Street 1:2004 HAYES ST STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2689
Practice Address - Country:US
Practice Address - Phone:615-324-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19572255A2300X
TN15698261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer