Provider Demographics
NPI:1568666097
Name:LISTOWSKI, HELENA (LMT, LLCC)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:LISTOWSKI
Suffix:
Gender:F
Credentials:LMT, LLCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 COLWICK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1703
Mailing Address - Country:US
Mailing Address - Phone:585-329-8643
Mailing Address - Fax:
Practice Address - Street 1:2349 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3025
Practice Address - Country:US
Practice Address - Phone:585-329-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015525-1172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY181230GGOtherPREFERRED CARE PROV #