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General NPI Number Information
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NPI Number | 1619216298
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Entity Type | Individual
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Provider Name | MRS. MAGDALENA IWANEK
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Gender | Female
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Dates
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Enumeration Date | 02/02/2013
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Last Update Date | 02/02/2013
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Provider Practice Location Address
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Address Line | 2020 W LAKE PARKER DR
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City | LAKELAND
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State | FL
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Zip | 33805-5005
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Country | US
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Telephone | 863-603-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 5412 RIVER ROCK RD
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City | LAKELAND
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State | FL
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Zip | 33809-0960
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Country | US
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Telephone | 863-608-0446
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Fax |
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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 | PT 12969
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License Number State | FL
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