Provider Demographics
NPI:1922104454
Name:MACIEJEWSKI, TERESA (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:MACIEJEWSKI
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 1:1910 SAINT JOE CENTER RD STE 33
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5000
Mailing Address - Country:US
Mailing Address - Phone:260-483-9933
Mailing Address - Fax:260-483-9931
Practice Address - Street 1:1910 SAINT JOE CENTER RD STE 33
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5000
Practice Address - Country:US
Practice Address - Phone:260-483-9933
Practice Address - Fax:260-483-9931
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004289A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN250440Medicare ID - Type Unspecified