Healthcare Provider Details

I. General information

NPI: 1396144044
Provider Name (Legal Business Name): JONATHAN DAVID SZCZESNIAK PT.,DPT,.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W BASS ST
KISSIMMEE FL
34741-5011
US

IV. Provider business mailing address

1522 E JEFFERSON ST
ORLANDO FL
32801-2144
US

V. Phone/Fax

Practice location:
  • Phone: 407-870-5959
  • Fax:
Mailing address:
  • Phone: 315-749-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: