Provider Demographics
NPI:1932104833
Name:WASIKOWSKI, ROBERTA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:J
Last Name:WASIKOWSKI
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 1:5478 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-681-0926
Mailing Address - Fax:716-681-9897
Practice Address - Street 1:5478 BROADWAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086
Practice Address - Country:US
Practice Address - Phone:716-681-0926
Practice Address - Fax:716-681-9897
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA044111Medicare ID - Type Unspecified