Healthcare Provider Details

I. General information

NPI: 1144149667
Provider Name (Legal Business Name): LAURA WAWRZYNIAKOWSKI PT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 KARYL ST
BURLINGTON WI
53105-2412
US

IV. Provider business mailing address

264 KARYL ST
BURLINGTON WI
53105-2412
US

V. Phone/Fax

Practice location:
  • Phone: 262-757-8727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4160-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: