Provider Demographics
NPI:1265896583
Name:CZEKA, EDYTA STANISLAWA (PTA)
Entity type:Individual
Prefix:
First Name:EDYTA
Middle Name:STANISLAWA
Last Name:CZEKA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16930 93RD RD N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2769
Mailing Address - Country:US
Mailing Address - Phone:561-401-5448
Mailing Address - Fax:
Practice Address - Street 1:1200 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5292
Practice Address - Country:US
Practice Address - Phone:561-694-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist