Provider Demographics
NPI:1063942092
Name:DASZYKOWSKI, MARTIN (DPT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DASZYKOWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36181 E LAKE RD STE 195
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3142
Mailing Address - Country:US
Mailing Address - Phone:727-797-7600
Mailing Address - Fax:
Practice Address - Street 1:29605 US HIGHWAY 19 N STE 150
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1538
Practice Address - Country:US
Practice Address - Phone:727-797-7600
Practice Address - Fax:727-797-7655
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26981208100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation