Provider Demographics
NPI:1952524076
Name:MARCINKIEWICZ, GENOWEFA (PTA)
Entity type:Individual
Prefix:
First Name:GENOWEFA
Middle Name:
Last Name:MARCINKIEWICZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10969 SE 175TH PL
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-0902
Mailing Address - Country:US
Mailing Address - Phone:352-347-8877
Mailing Address - Fax:352-347-9477
Practice Address - Street 1:10969 SE 175TH PL
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-0902
Practice Address - Country:US
Practice Address - Phone:352-347-8877
Practice Address - Fax:352-347-9477
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20192225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant