Healthcare Provider Details

I. General information

NPI: 1295747434
Provider Name (Legal Business Name): JACQUELINE URBANCZYK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD VA-CENTER FOR REHABILITATION AND EXTENDED CARE
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

150 MUIR RD VA-CENTER FOR REHABILITATION AND EXTENDED CARE
MARTINEZ CA
94553-4668
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-4737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012038
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: