Provider Demographics
NPI:1346351343
Name:CZARNECKI, PAUL STEVEN (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STEVEN
Last Name:CZARNECKI
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 1:2050 S LINDEN RD
Mailing Address - Street 2:STE 304
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4161
Mailing Address - Country:US
Mailing Address - Phone:810-733-8222
Mailing Address - Fax:810-733-8863
Practice Address - Street 1:861 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7383
Practice Address - Country:US
Practice Address - Phone:810-953-0095
Practice Address - Fax:810-953-0031
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30610OtherBLUE CROSS
MI0M06280Medicare ID - Type Unspecified