Provider Demographics
NPI:1801369343
Name:WAWRZYNIAK, ALBERTO JOSE (ATC)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:JOSE
Last Name:WAWRZYNIAK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2070
Mailing Address - Country:US
Mailing Address - Phone:419-509-2549
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE PARK CRONIN ATHLETIC CENTER
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45469-1044
Practice Address - Country:US
Practice Address - Phone:937-229-4460
Practice Address - Fax:937-229-5448
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0064762255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer