Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT 19928 | CA |
NPI | 1134389919 |
---|---|
Provider Name | Alicja Janiczek |
First Address | Oakland, CA 94609-3510 |
Second Address | Oakland, CA 94609-3510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2008 |
Last Update Date | 14/06/2008 |