Healthcare Provider Details

I. General information

NPI: 1154656643
Provider Name (Legal Business Name): PAULINA MIERZEJEWSKI MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LOWELL RD APT 203
NORTH READING MA
01864-1679
US

IV. Provider business mailing address

106 LOWELL RD APT 203
NORTH READING MA
01864-1679
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-0031
  • Fax: 855-232-8604
Mailing address:
  • Phone: 716-883-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025578
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21766
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: