Provider Demographics
NPI:1205172426
Name:FURMAN, JANUSZ MAREK (PT)
Entity type:Individual
Prefix:MR
First Name:JANUSZ
Middle Name:MAREK
Last Name:FURMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 THORNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3797
Mailing Address - Country:US
Mailing Address - Phone:636-561-7105
Mailing Address - Fax:
Practice Address - Street 1:617 THORNRIDGE DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3797
Practice Address - Country:US
Practice Address - Phone:636-561-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist