Provider Demographics
NPI:1881030054
Name:RADZIWON, PIOTR (LMT)
Entity Type:Individual
Prefix:
First Name:PIOTR
Middle Name:
Last Name:RADZIWON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 SILAS DEANE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2332
Mailing Address - Country:US
Mailing Address - Phone:860-721-0249
Mailing Address - Fax:
Practice Address - Street 1:2049 SILAS DEANE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2332
Practice Address - Country:US
Practice Address - Phone:860-721-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist