Provider Demographics
NPI:1356047971
Name:SZYMCZAK, THOMAS E (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:SZYMCZAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14940 SOUTHEASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7121
Mailing Address - Country:US
Mailing Address - Phone:317-697-6586
Mailing Address - Fax:
Practice Address - Street 1:7626 E 88TH PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1261
Practice Address - Country:US
Practice Address - Phone:317-697-6586
Practice Address - Fax:317-436-0441
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005098A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist