Provider Demographics
NPI:1922157460
Name:ROSTKOWSKI, JOHN (MSPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ROSTKOWSKI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BLACKTHORN LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3703
Mailing Address - Country:US
Mailing Address - Phone:845-216-4213
Mailing Address - Fax:
Practice Address - Street 1:34 MIDROCKS DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1626
Practice Address - Country:US
Practice Address - Phone:203-842-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026331225100000X
CT007600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist