Provider Demographics
NPI:1518480722
Name:JASTRZAB, MARCIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARCIN
Middle Name:
Last Name:JASTRZAB
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 W GRAPEVINE MILLS CIR APT 6003
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2150
Mailing Address - Country:US
Mailing Address - Phone:551-580-6073
Mailing Address - Fax:
Practice Address - Street 1:2311 W GRAPEVINE MILLS CIR APT 6003
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2150
Practice Address - Country:US
Practice Address - Phone:551-580-6073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist