Provider Demographics
NPI:1942960794
Name:WLODARCZAK, ALEXANDER GREGORY (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GREGORY
Last Name:WLODARCZAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9144
Mailing Address - Country:US
Mailing Address - Phone:269-372-1027
Mailing Address - Fax:
Practice Address - Street 1:6565 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9144
Practice Address - Country:US
Practice Address - Phone:269-372-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501301884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist