Provider Demographics
NPI:1578895249
Name:KWIECINSKA, JOLANTA (DPT)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:KWIECINSKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BIRCH PL
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1468
Mailing Address - Country:US
Mailing Address - Phone:347-453-4008
Mailing Address - Fax:
Practice Address - Street 1:1061 N BROADWAY
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1853
Practice Address - Country:US
Practice Address - Phone:631-454-6387
Practice Address - Fax:631-454-6303
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist