Healthcare Provider Details

I. General information

NPI: 1558650804
Provider Name (Legal Business Name): REBECCA WOJCIECHOWSKY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13406 NORTHUMBERLAND CIR
WELLINGTON FL
33414-8914
US

IV. Provider business mailing address

13406 NORTHUMBERLAND CIR
WELLINGTON FL
33414-8914
US

V. Phone/Fax

Practice location:
  • Phone: 561-324-6801
  • Fax:
Mailing address:
  • Phone: 561-324-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT19598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: