Provider Demographics
NPI:1407492358
Name:PIECZARA, TIMOTHY WILLIAM (MS, LAT, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:PIECZARA
Suffix:
Gender:M
Credentials:MS, LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 W NORTH AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2275
Mailing Address - Country:US
Mailing Address - Phone:724-809-7968
Mailing Address - Fax:
Practice Address - Street 1:11011 W NORTH AVE APT 119
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2275
Practice Address - Country:US
Practice Address - Phone:724-809-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0966488146N00000X
2255A2300X
WI3124-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic