Provider Demographics
NPI:1518431832
Name:OLSZEWSKI, JACEK (PT)
Entity Type:Individual
Prefix:MR
First Name:JACEK
Middle Name:
Last Name:OLSZEWSKI
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 1:409 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-1007
Mailing Address - Country:US
Mailing Address - Phone:248-906-1439
Mailing Address - Fax:
Practice Address - Street 1:400 RIVER ST
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-1614
Practice Address - Country:US
Practice Address - Phone:906-884-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4476852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist