Provider Demographics
NPI:1366679151
Name:CZECHOWSKI, MARY ANN (PTA)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:CZECHOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 BLUE HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8493
Mailing Address - Country:US
Mailing Address - Phone:610-965-6808
Mailing Address - Fax:610-965-6808
Practice Address - Street 1:6642 BLUE HEATHER CT
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8493
Practice Address - Country:US
Practice Address - Phone:610-965-6808
Practice Address - Fax:610-965-6808
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1001758225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant