Basic Information
| Provider Information | |||||||||
| NPI: | 1417179425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMCZAK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3530 PEACH ST | ||||||||
| Address2: | SUITE LL1 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165082768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148605000 | ||||||||
| FaxNumber: | 8148605050 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 SASSAFRAS ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525231 | ||||||||
| FaxNumber: | 8144527855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016157 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.