Provider Demographics
NPI:1336762343
Name:SAJCZUK, JAYMES JOSEPH WILLIAM (DPT)
Entity Type:Individual
Prefix:
First Name:JAYMES
Middle Name:JOSEPH WILLIAM
Last Name:SAJCZUK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 SOUTHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3783
Mailing Address - Country:US
Mailing Address - Phone:208-746-1418
Mailing Address - Fax:208-746-4123
Practice Address - Street 1:678 SOUTHWAY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3783
Practice Address - Country:US
Practice Address - Phone:208-746-1418
Practice Address - Fax:208-746-4123
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-7001OtherSTATE LICENSE