Provider Demographics
NPI:1497236566
Name:NIEDZWIECKI, MARCIN (PT)
Entity Type:Individual
Prefix:
First Name:MARCIN
Middle Name:
Last Name:NIEDZWIECKI
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 1:9085 RANCH RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-5094
Mailing Address - Country:US
Mailing Address - Phone:720-348-7930
Mailing Address - Fax:720-348-7995
Practice Address - Street 1:9085 RANCH RIVER CIR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5094
Practice Address - Country:US
Practice Address - Phone:720-348-7930
Practice Address - Fax:720-348-7995
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist