Provider Demographics
NPI:1467652248
Name:SZYMCZYK, ROGER W (LPT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:W
Last Name:SZYMCZYK
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,LPT
Mailing Address - Street 1:2425 LYNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-7774
Mailing Address - Country:US
Mailing Address - Phone:704-364-4429
Mailing Address - Fax:
Practice Address - Street 1:1361 E GARRISON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5146
Practice Address - Country:US
Practice Address - Phone:704-864-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic