Provider Demographics
NPI:1871802298
Name:STANISZEWSKI, JAMIE M (PT)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:M
Last Name:STANISZEWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 EDGEWATER DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-3030
Mailing Address - Country:US
Mailing Address - Phone:414-839-1720
Mailing Address - Fax:
Practice Address - Street 1:7700 EDGEWATER DR
Practice Address - Street 2:SUITE 225
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-3030
Practice Address - Country:US
Practice Address - Phone:510-638-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11552-024225100000X
CA37542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist