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NPI Code Detail

MEDICARE: DR. ROBERT JOSEPH WIERZOWIECKI PT, DPT

MEDICARE: DR. ROBERT JOSEPH WIERZOWIECKI PT, DPT
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
1225100000XPhysical Therapist1135093TX

General Provider Information

NPI Number : 1588799530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT JOSEPH WIERZOWIECKI PT, DPT
Provider Business Mailing Address
First Line : 1309 GLENEAGLES DR
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-3310
Country : US
Telephone Number : 325-651-6918
Fax Number : 325-944-1660
Provider Business Practice Location Address
First Line : 5455 KNICKERBOCKER RD
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-7711
Country : US
Telephone Number : 325-944-1600
Fax Number : 325-944-1660
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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