Provider Demographics
NPI:1770347551
Name:MACIEJEWSKI, JAMES ETHAN (DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ETHAN
Last Name:MACIEJEWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10562 MALOIAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9185
Mailing Address - Country:US
Mailing Address - Phone:219-310-9125
Mailing Address - Fax:
Practice Address - Street 1:10033 WICKER AVE STE 7&8
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8776
Practice Address - Country:US
Practice Address - Phone:219-213-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist