Provider Demographics
NPI:1255880464
Name:MIKOLAJCZYK, STANLEY
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:MIKOLAJCZYK
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 1:301 TELLURIDE ST
Mailing Address - Street 2:3121
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-3433
Mailing Address - Country:US
Mailing Address - Phone:830-570-8652
Mailing Address - Fax:
Practice Address - Street 1:301 TELLURIDE ST
Practice Address - Street 2:3121
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-3433
Practice Address - Country:US
Practice Address - Phone:830-570-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer