Provider Demographics
NPI:1407897408
Name:SMOLCZYNSKI, VINCENT (PT)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:SMOLCZYNSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CHEW ST
Mailing Address - Street 2:STE 206
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102
Mailing Address - Country:US
Mailing Address - Phone:570-988-0925
Mailing Address - Fax:570-988-0919
Practice Address - Street 1:451 CHEW ST
Practice Address - Street 2:STE 206
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:570-988-0925
Practice Address - Fax:570-988-0919
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003385L225100000X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152803Medicare ID - Type Unspecified
R06355Medicare UPIN