Provider Demographics
NPI:1033273115
Name:CZERNIECKI, JANINE LOUISE (PT OT)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:LOUISE
Last Name:CZERNIECKI
Suffix:
Gender:F
Credentials:PT OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 BAGLEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16030 BOTHELL EVERETT HWY
Practice Address - Street 2:STE 140
Practice Address - City:MILLCREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1273
Practice Address - Country:US
Practice Address - Phone:425-338-9005
Practice Address - Fax:425-337-0931
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000030142251P0200X
WAOT00000368225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR36130OtherREGENCE PT PIN
WA8367575Medicaid
WA8348294Medicaid
WA0368CZOtherREGENCE OT PIN