Provider Demographics
NPI:1972974467
Name:MARCINIAK, WOJSLAW
Entity Type:Individual
Prefix:
First Name:WOJSLAW
Middle Name:
Last Name:MARCINIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 ELM ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5108
Mailing Address - Country:US
Mailing Address - Phone:307-324-8240
Mailing Address - Fax:307-324-8339
Practice Address - Street 1:2221 ELM ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5108
Practice Address - Country:US
Practice Address - Phone:307-324-8240
Practice Address - Fax:307-324-8339
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist