Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PTL.0014801 | CO |
NPI | 1396266813 |
---|---|
Provider Name | Wesley Ostrzycki |
First Address | Edison, NJ 08837-3132 |
Second Address | Tinton Falls, NJ 07712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 06/07/2017 |