Provider Demographics
NPI:1598987554
Name:MARCINKOWSKI, LORRAINE JOYLL (PT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:JOYLL
Last Name:MARCINKOWSKI
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 1:15 ALTA SIERRA PL
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-2201
Mailing Address - Country:US
Mailing Address - Phone:925-362-4235
Mailing Address - Fax:
Practice Address - Street 1:3730 MT DIABLO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3635
Practice Address - Country:US
Practice Address - Phone:925-284-4486
Practice Address - Fax:925-362-4236
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT154240Medicare ID - Type Unspecified