Provider Demographics
NPI:1891933545
Name:MYSIUK, FLORDELIZA BERNARDO (PT)
Entity Type:Individual
Prefix:MRS
First Name:FLORDELIZA
Middle Name:BERNARDO
Last Name:MYSIUK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HAMILTON ST
Mailing Address - Street 2:APT. A
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5535
Mailing Address - Country:US
Mailing Address - Phone:732-986-8614
Mailing Address - Fax:
Practice Address - Street 1:440 HAMILTON ST
Practice Address - Street 2:APT. A
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5535
Practice Address - Country:US
Practice Address - Phone:732-986-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01300500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist