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General NPI Number Information
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NPI Number | 1497236566
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Entity Type | Individual
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Provider Name | MARCIN NIEDZWIECKI PT
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Gender | Male
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 9085 RANCH RIVER CIR
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-5094
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Country | US
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Telephone | 720-348-7930
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Fax | 720-348-7995
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Provider Business Mailing Address
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Address Line | 9085 RANCH RIVER CIR
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-5094
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Country | US
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Telephone | 720-348-7930
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Fax | 720-348-7995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0012129
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License Number State | CO
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