Provider Demographics
NPI:1255946281
Name:MARCINIAK, ALEX ANTHONY (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:ANTHONY
Last Name:MARCINIAK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2065
Mailing Address - Country:US
Mailing Address - Phone:262-358-5634
Mailing Address - Fax:
Practice Address - Street 1:3400 COUNTY ROAD F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0737
Practice Address - Country:US
Practice Address - Phone:262-358-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15196-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty