Provider Demographics
NPI:1790375533
Name:PIETROWSKI, JESSICA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:PIETROWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1425
Mailing Address - Country:US
Mailing Address - Phone:716-706-8951
Mailing Address - Fax:
Practice Address - Street 1:11861 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-9563
Practice Address - Country:US
Practice Address - Phone:716-449-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028174-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist