Provider Demographics
NPI:1245458041
Name:CZARNECKI, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CZARNECKI
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 1:6020 W MAPLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4409
Mailing Address - Country:US
Mailing Address - Phone:248-851-6999
Mailing Address - Fax:
Practice Address - Street 1:6020 W MAPLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4409
Practice Address - Country:US
Practice Address - Phone:248-851-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501004042OtherPT LICENSE #