Provider Demographics
NPI:1700977519
Name:KASPRZYK, PIOTR G (PT)
Entity Type:Individual
Prefix:MR
First Name:PIOTR
Middle Name:G
Last Name:KASPRZYK
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 1:43740 GARFIELD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038
Mailing Address - Country:US
Mailing Address - Phone:586-228-0270
Mailing Address - Fax:586-228-9019
Practice Address - Street 1:43740 GARFIELD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-228-0270
Practice Address - Fax:586-228-9019
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP1579001Medicare ID - Type Unspecified