Basic Information
| Provider Information | |||||||||
| NPI: | 1992869879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CZERKOWICZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 SUMMER ST | ||||||||
| Address2: | |||||||||
| City: | BLACKSTONE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015041212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088831780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1351 SMITH ST | ||||||||
| Address2: | |||||||||
| City: | N PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029113340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013535520 | ||||||||
| FaxNumber: | 4013532909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT540 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 4441 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.