Provider Demographics
NPI:1811143530
Name:TOMCZYKOWSKI, ALAN R (DPT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:TOMCZYKOWSKI
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 1:981 HIGH HOUSE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3510
Mailing Address - Country:US
Mailing Address - Phone:919-388-0111
Mailing Address - Fax:919-388-8668
Practice Address - Street 1:4701 CREEDMOOR RD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4500
Practice Address - Country:US
Practice Address - Phone:919-676-2001
Practice Address - Fax:919-676-0023
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009619A225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200918170Medicaid
IN000000586038OtherBLUE CROSS AND BLUE SHIELD
IN000000585391OtherBLUE CROSS AND BLUE SHIELD
IN000000585391OtherBLUE CROSS AND BLUE SHIELD
IN255480JJMedicare PIN
IN000000586038OtherBLUE CROSS AND BLUE SHIELD