Provider Demographics
NPI:1750677878
Name:JANIKOWSKI, ANDREA KAY (DPT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:KAY
Last Name:JANIKOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 HOOVER ROAD
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-346-0275
Mailing Address - Fax:715-346-0307
Practice Address - Street 1:3500 HOOVER ROAD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-346-0275
Practice Address - Fax:715-346-0307
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004739225100000X
WI11904-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist