Provider Demographics
NPI:1568614519
Name:ANDRZEJEWSKI, XENIA YAWDACHA (PT)
Entity Type:Individual
Prefix:
First Name:XENIA
Middle Name:YAWDACHA
Last Name:ANDRZEJEWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BLUFFS
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:765 W GRANT ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6810
Practice Address - Country:US
Practice Address - Phone:813-743-3701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist