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NPI Code Detail

MEDICARE: MS. MISCHA ELIZABETH JEMIONEK AT

MEDICARE: MS. MISCHA ELIZABETH JEMIONEK AT
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
12255A2300XAthletic Trainer25MT00164000NJ
2225100000XPhysical Therapist32848AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
132848OTHERAZPT

General Provider Information

NPI Number : 1528344199
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MISCHA ELIZABETH JEMIONEK AT
Provider Business Mailing Address
First Line : 4800 N 44TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-3800
Country : US
Telephone Number : 602-808-8989
Fax Number :
Provider Business Practice Location Address
First Line : 4800 N 44TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-3800
Country : US
Telephone Number : 602-808-8989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2011
Last Update Date : 02/14/2023

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