Healthcare Provider Details

I. General information

NPI: 1063942092
Provider Name (Legal Business Name): MARTIN DASZYKOWSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29605 US HIGHWAY 19 N STE 150
CLEARWATER FL
33761-1538
US

IV. Provider business mailing address

29605 US HIGHWAY 19 N STE 150
CLEARWATER FL
33761-1538
US

V. Phone/Fax

Practice location:
  • Phone: 727-797-7600
  • Fax: 727-797-7655
Mailing address:
  • Phone: 727-797-7600
  • Fax: 727-797-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT26981
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT26981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: