Provider Demographics
NPI:1821033648
Name:WASIK, MITCHELL (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:WASIK
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HOLLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1722
Mailing Address - Country:US
Mailing Address - Phone:415-338-1576
Mailing Address - Fax:415-338-1967
Practice Address - Street 1:1600 HOLLOWAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1722
Practice Address - Country:US
Practice Address - Phone:415-338-1576
Practice Address - Fax:415-338-1967
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer