MEDICARE: MRS. ROBERTA J WASIKOWSKI 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	7383	NY

General Provider Information

NPI Number	:	1932104833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBERTA J WASIKOWSKI PT

Provider Business Mailing Address
First Line	:	5478 BROADWAY
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086
Country	:	US
Telephone Number	:	716-681-0926
Fax Number	:	716-681-9897

Provider Business Practice Location Address
First Line	:	5478 BROADWAY
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086
Country	:	US
Telephone Number	:	716-681-0926
Fax Number	:	716-681-9897

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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