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General NPI Number Information
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NPI Number | 1801369343
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Entity Type | Individual
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Provider Name | ALBERTO JOSE WAWRZYNIAK ATC
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Gender | Male
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 300 COLLEGE PARK CRONIN ATHLETIC CENTER
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City | DAYTON
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State | OH
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Zip | 45469-1044
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Country | US
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Telephone | 937-229-4460
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Fax | 937-229-5448
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Provider Business Mailing Address
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Address Line | 5626 NORTHVIEW DR
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City | SYLVANIA
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State | OH
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Zip | 43560-2070
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Country | US
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Telephone | 419-509-2549
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT006476
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License Number State | OH
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