Provider Demographics
NPI:1376873695
Name:WOJCIECHOWSKI, ANDRZEJ P
Entity Type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:P
Last Name:WOJCIECHOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDRZEJ
Other - Middle Name:P
Other - Last Name:WOJCIECHOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT, MOMT
Mailing Address - Street 1:1133 BANYAN WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4343
Mailing Address - Country:US
Mailing Address - Phone:650-738-3539
Mailing Address - Fax:
Practice Address - Street 1:1133 BANYAN WAY
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-4343
Practice Address - Country:US
Practice Address - Phone:650-738-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 19118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 19118OtherPHYSICAL THERAPY LICENSE NUMBER