Provider Demographics
NPI:1699543975
Name:WRESILO, WILLIAM KAZMIR (DPT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KAZMIR
Last Name:WRESILO
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 1:3272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4819
Mailing Address - Country:US
Mailing Address - Phone:475-210-7550
Mailing Address - Fax:
Practice Address - Street 1:3272 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4819
Practice Address - Country:US
Practice Address - Phone:475-210-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist