Provider Demographics
NPI:1497710198
Name:WIERZBICKI, EDWARD JOHN (MPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:WIERZBICKI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 ABBINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1601
Mailing Address - Country:US
Mailing Address - Phone:717-540-0262
Mailing Address - Fax:
Practice Address - Street 1:2850 COMMERCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9383
Practice Address - Country:US
Practice Address - Phone:717-541-4348
Practice Address - Fax:717-541-9576
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009688L225100000X
PADAPT001214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU37902Medicare ID - Type Unspecified
PA043577PX9Medicare PIN