Provider Demographics
NPI:1457528689
Name:JEZIORSKA, BEATA
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:JEZIORSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 NE 20TH AVE
Mailing Address - Street 2:APT.25
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1056
Mailing Address - Country:US
Mailing Address - Phone:561-386-9598
Mailing Address - Fax:
Practice Address - Street 1:3333 NE 20TH AVE
Practice Address - Street 2:APT.25
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33306-1056
Practice Address - Country:US
Practice Address - Phone:561-386-9598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49269225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist