Healthcare Provider Details

I. General information

NPI: 1689062812
Provider Name (Legal Business Name): JOSEPH PIETRYKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SE 24TH RD
OCALA FL
34471-6005
US

IV. Provider business mailing address

9908 SW 41ST AVE
OCALA FL
34476-4198
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-8900
  • Fax:
Mailing address:
  • Phone: 724-448-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: