Provider Demographics
NPI:1578170536
Name:DRZEN, JOANNA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:DRZEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 163RD ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2681
Mailing Address - Country:US
Mailing Address - Phone:917-943-6090
Mailing Address - Fax:
Practice Address - Street 1:4133 163RD ST APT 2A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2681
Practice Address - Country:US
Practice Address - Phone:917-943-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011898-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant