Provider Demographics
NPI:1225037625
Name:MARCINKOWSKI, STEVEN JOSEPH
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:MARCINKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 MT DIABLO BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3774
Mailing Address - Country:US
Mailing Address - Phone:925-284-4486
Mailing Address - Fax:925-362-4236
Practice Address - Street 1:3675 MT DIABLO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3774
Practice Address - Country:US
Practice Address - Phone:925-284-4486
Practice Address - Fax:925-362-4236
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT134520OtherBLUE SHIELD
CA0PT134520Medicare ID - Type Unspecified
CA0PT134520Medicare PIN