Provider Demographics
NPI:1356688972
Name:ZMIRSKI, MARIUSZ W (PT)
Entity Type:Individual
Prefix:MR
First Name:MARIUSZ
Middle Name:W
Last Name:ZMIRSKI
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 1:2068 GLENFIELDFIELD CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5035
Mailing Address - Country:US
Mailing Address - Phone:954-649-9992
Mailing Address - Fax:
Practice Address - Street 1:2068 GLENFIELDFIELD CROSSING CT
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5035
Practice Address - Country:US
Practice Address - Phone:954-649-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist