Provider Demographics
NPI:1336998251
Name:WITCZAK, JULIE SARAH (LMT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:SARAH
Last Name:WITCZAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2641
Mailing Address - Country:US
Mailing Address - Phone:813-532-6464
Mailing Address - Fax:
Practice Address - Street 1:2360 SWEET HOME RD STE 8
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2331
Practice Address - Country:US
Practice Address - Phone:716-547-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist