Provider Demographics
NPI:1073957007
Name:STRYJEWSKI, JACEK (LMT)
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:
Last Name:STRYJEWSKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ROCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-3008
Mailing Address - Country:US
Mailing Address - Phone:203-554-0079
Mailing Address - Fax:
Practice Address - Street 1:126 ROCKWELL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-3008
Practice Address - Country:US
Practice Address - Phone:203-554-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist