Provider Demographics
NPI:1316236870
Name:WOZNIAKEWICZ, EDWARD (ATC, LAT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:WOZNIAKEWICZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9554
Mailing Address - Country:US
Mailing Address - Phone:413-687-4622
Mailing Address - Fax:
Practice Address - Street 1:12 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-9554
Practice Address - Country:US
Practice Address - Phone:413-687-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer