Provider Demographics
NPI:1487034781
Name:CIESINSKA-BERDOZ, JOLANTA
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:CIESINSKA-BERDOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 FOX HUNT TRL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7365
Mailing Address - Country:US
Mailing Address - Phone:757-345-8140
Mailing Address - Fax:
Practice Address - Street 1:3945 FOX HUNT TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7365
Practice Address - Country:US
Practice Address - Phone:757-345-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604066225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant