Provider Demographics
NPI:1407897408
Name:SMOLCZYNSKI, VINCENT (PT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:SMOLCZYNSKI
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 1:451 CHEW ST
Mailing Address - Street 2:STE 206
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102
Mailing Address - Country:US
Mailing Address - Phone:570-988-0925
Mailing Address - Fax:570-988-0919
Practice Address - Street 1:451 CHEW ST
Practice Address - Street 2:STE 206
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:570-988-0925
Practice Address - Fax:570-988-0919
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003385L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152803Medicare ID - Type Unspecified
R06355Medicare UPIN