Provider Demographics
NPI:1770651234
Name:PASZKIEWICZ, JOHN PHILIP (MSPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:PASZKIEWICZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:1725 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3349
Practice Address - Country:US
Practice Address - Phone:270-467-9969
Practice Address - Fax:270-467-9970
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT003522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760411342OtherGROUP NPI
KYGROUP#91011148Medicaid
KYGROUP #184501Medicare ID - Type Unspecified