Provider Demographics
NPI:1649203779
Name:BODZIANOWSKI, TOMASZ (PT)
Entity type:Individual
Prefix:MR
First Name:TOMASZ
Middle Name:
Last Name:BODZIANOWSKI
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 1:810 ANTOINETTE LN APT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3323
Mailing Address - Country:US
Mailing Address - Phone:650-273-1810
Mailing Address - Fax:
Practice Address - Street 1:45 SOUTHGATE AVE STE 201
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1413
Practice Address - Country:US
Practice Address - Phone:650-985-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist