Provider Demographics
NPI:1114179066
Name:ZAWADZKI, ALEXANDER O (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:O
Last Name:ZAWADZKI
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 1:1915 NW AMBERGLEN PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6938
Mailing Address - Country:US
Mailing Address - Phone:503-888-5082
Mailing Address - Fax:
Practice Address - Street 1:2373 NW 185TH AVE STE 1001
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7076
Practice Address - Country:US
Practice Address - Phone:503-888-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT13354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist