Provider Demographics
NPI:1477759066
Name:KLACZYNSKI, EDYTA MAGDALENA (PTA)
Entity Type:Individual
Prefix:
First Name:EDYTA
Middle Name:MAGDALENA
Last Name:KLACZYNSKI
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 1:6429 146TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3520
Mailing Address - Country:US
Mailing Address - Phone:425-743-4912
Mailing Address - Fax:
Practice Address - Street 1:21400 72ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7702
Practice Address - Country:US
Practice Address - Phone:425-775-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant