Provider Demographics
NPI:1003136227
Name:JANECEK, DARIA K (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DARIA
Middle Name:K
Last Name:JANECEK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8458 PERSIAN TER
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8852
Mailing Address - Country:US
Mailing Address - Phone:315-395-4685
Mailing Address - Fax:315-699-7022
Practice Address - Street 1:8458 PERSIAN TER
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8852
Practice Address - Country:US
Practice Address - Phone:315-395-4685
Practice Address - Fax:315-699-7022
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012119-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty