Provider Demographics
NPI:1174245880
Name:ORIHUELA, WALTER A (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:A
Last Name:ORIHUELA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ORIHUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1567 DEERFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1567 DEERFIELD PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2653
Practice Address - Country:US
Practice Address - Phone:847-520-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist