Provider Demographics
NPI:1033444054
Name:PIEKOS, IWONA (PT)
Entity Type:Individual
Prefix:MS
First Name:IWONA
Middle Name:
Last Name:PIEKOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 OCEAN AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2556
Mailing Address - Country:US
Mailing Address - Phone:310-396-8771
Mailing Address - Fax:310-452-3240
Practice Address - Street 1:5080 SAN FELICIANO DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1623
Practice Address - Country:US
Practice Address - Phone:805-358-3392
Practice Address - Fax:818-592-0673
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19191OtherPHYSICAL THERAPY LICENSE