Provider Demographics
NPI:1801148523
Name:CZARNIECKI, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CZARNIECKI
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 1:1037 CLEAR POINT CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1173
Mailing Address - Country:US
Mailing Address - Phone:248-338-7600
Mailing Address - Fax:248-338-8323
Practice Address - Street 1:43902 WOODWARD AVE STE 120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5021
Practice Address - Country:US
Practice Address - Phone:248-338-7600
Practice Address - Fax:248-338-8323
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010045062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic