Provider Demographics
NPI:1902806367
Name:FEDORCZYK, FRANK (PT, DPT, OCS)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:FEDORCZYK
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 AMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-4545
Mailing Address - Country:US
Mailing Address - Phone:215-962-9557
Mailing Address - Fax:
Practice Address - Street 1:6009 AMBERLY DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-4545
Practice Address - Country:US
Practice Address - Phone:215-962-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005649L225100000X
NJ40QA00339700225100000X
FLPT32010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902806367OtherCHAMPUS TRICARE
PA504364OtherPABS HIGHMARK
PA126772VKFMedicare PIN
NJ22-2336723OtherHORIZON BC/BS OF NJ
PA504364OtherPABS HIGHMARK