Provider Demographics
NPI:1891904736
Name:PETYNIA, AGNIESZKA
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:PETYNIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PETYNIA
Other - Middle Name:
Other - Last Name:CZOPIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-340-9303
Mailing Address - Fax:818-340-4839
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 501
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-340-9303
Practice Address - Fax:818-340-4839
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT208802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT20880OtherPT LICENSE