Provider Demographics
NPI:1598121352
Name:WAWRZYNIAK, LORETTA (PT)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:WAWRZYNIAK
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 1:1333 LAKE BALDWIN LN UNIT 111
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:765 W STATE ROAD 434 STE A
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4936
Practice Address - Country:US
Practice Address - Phone:828-698-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2023-10-16
Deactivation Date:2023-10-05
Deactivation Code:
Reactivation Date:2023-10-16
Provider Licenses
StateLicense IDTaxonomies
NCP18329225100000X, 2251X0800X
FLPT 57762251X0800X
FLPT5776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic