MEDICARE: PRZEMYSLAW BUCZEK P.T.

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	1078327	TX

General Provider Information

NPI Number	:	1588052682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRZEMYSLAW BUCZEK P.T.

Provider Business Mailing Address
First Line	:	5007 WIGTON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5327
Country	:	US
Telephone Number	:	713-726-0398
Fax Number	:

Provider Business Practice Location Address
First Line	:	5007 WIGTON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5327
Country	:	US
Telephone Number	:	713-726-0398
Fax Number	:

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

Provider Enumeration Date	:	12/26/2014
Last Update Date	:	12/26/2014

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