Provider Demographics
NPI:1215267141
Name:RADZAK, JOHN BYRON
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BYRON
Last Name:RADZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 SPLIT ROCK LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-2020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3727 SPLIT ROCK LIGHTHOUSE RD
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-2020
Practice Address - Country:US
Practice Address - Phone:218-220-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist