Provider Demographics
NPI:1295848869
Name:TALARCZYK, NICHOLAS (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:TALARCZYK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2000
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:730 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1014
Practice Address - Country:US
Practice Address - Phone:920-727-9878
Practice Address - Fax:920-727-9903
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3245-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00441549OtherRAILROAD MEDICARE
WI650019400OtherRAILROAD MEDICARE
WI650019368OtherRAILROAD MEDICARE
WI40106500Medicaid
WI064S6TAOtherBCBS OF MN
WI118952OtherSECURITY HEALTH PLAN
WI40106500Medicaid
WI118952OtherSECURITY HEALTH PLAN
WI064S6TAOtherBCBS OF MN
WI000286005Medicare ID - Type Unspecified