Provider Demographics
NPI:1043397128
Name:MIKOLAJEWSKI, GLYNDA LEIGH (PT)
Entity Type:Individual
Prefix:MISS
First Name:GLYNDA
Middle Name:LEIGH
Last Name:MIKOLAJEWSKI
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 1:919 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-1623
Mailing Address - Country:US
Mailing Address - Phone:937-271-4721
Mailing Address - Fax:937-381-5003
Practice Address - Street 1:6215 TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3646
Practice Address - Country:US
Practice Address - Phone:937-236-8111
Practice Address - Fax:937-236-4877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-01508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist