Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT33590 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT33590 | FL |
NPI | 1215492996 |
---|---|
Provider Name | Steven Alexander Wietrzykowski |
First Address | Gainesville, FL 32607-2013 |
Second Address | Gainesville, FL 32606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2019 |
Last Update Date | 06/02/2019 |