MEDICARE: MS. IWONA PIEKOS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	19191	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19191	OTHER	CA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1033444054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IWONA PIEKOS PT

Provider Business Mailing Address
First Line	:	2101 OCEAN AVE APT 9
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2556
Country	:	US
Telephone Number	:	310-396-8771
Fax Number	:	310-452-3240

Provider Business Practice Location Address
First Line	:	5080 SAN FELICIANO DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-1623
Country	:	US
Telephone Number	:	805-358-3392
Fax Number	:	818-592-0673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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