Provider Demographics
NPI:1235402462
Name:WOJCIECHOWSKI, MARK (ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WOJCIECHOWSKI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 DAMASCUS DR
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-9761
Mailing Address - Country:US
Mailing Address - Phone:610-282-1100
Mailing Address - Fax:610-282-1404
Practice Address - Street 1:74 DAMASCUS DR
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9761
Practice Address - Country:US
Practice Address - Phone:610-282-1100
Practice Address - Fax:610-282-1404
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001967A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer