MEDICARE: MR. MAREK PIATKOWSKINAZARRO RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT15084	CA

General Provider Information

NPI Number	:	1326091851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAREK PIATKOWSKINAZARRO RPT

Provider Business Mailing Address
First Line	:	11631 VICTORY BLVD
Second Line	:	SUITE 201
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-3572
Country	:	US
Telephone Number	:	626-437-3986
Fax Number	:

Provider Business Practice Location Address
First Line	:	11631 VICTORY BLVD
Second Line	:	SUITE 201
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91606-3572
Country	:	US
Telephone Number	:	626-437-3986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/03/2011

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