Provider Demographics
NPI:1003041922
Name:JANICZEK, JOSEPH (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:JANICZEK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34413 WHISPERING OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGE MANOR
Mailing Address - State:FL
Mailing Address - Zip Code:33523-8958
Mailing Address - Country:US
Mailing Address - Phone:813-624-3700
Mailing Address - Fax:352-583-6379
Practice Address - Street 1:34413 WHISPERING OAKS BLVD
Practice Address - Street 2:
Practice Address - City:RIDGE MANOR
Practice Address - State:FL
Practice Address - Zip Code:33523-8958
Practice Address - Country:US
Practice Address - Phone:813-624-3700
Practice Address - Fax:352-583-6379
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44165172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist