Provider Demographics
NPI:1003672791
Name:SZYMANOWICZ, JACEK A (PT)
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:A
Last Name:SZYMANOWICZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4936
Mailing Address - Country:US
Mailing Address - Phone:772-225-8908
Mailing Address - Fax:772-225-0843
Practice Address - Street 1:4287 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4936
Practice Address - Country:US
Practice Address - Phone:772-223-3440
Practice Address - Fax:772-225-0843
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty