Provider Demographics
NPI:1992938096
Name:FEDORCZYK, MARYJANE (PT PHD, CHT, ATC)
Entity type:Individual
Prefix:DR
First Name:MARYJANE
Middle Name:
Last Name:FEDORCZYK
Suffix:
Gender:F
Credentials:PT PHD, CHT, ATC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:FEDORCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT PHD, CHT, ATC
Mailing Address - Street 1:245 N 15TH ST
Mailing Address - Street 2:MAIL STOP 502
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1101
Mailing Address - Country:US
Mailing Address - Phone:215-762-4680
Mailing Address - Fax:
Practice Address - Street 1:245 N 15TH ST
Practice Address - Street 2:MAIL STOP 502
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006083L2251H1200X
NJ40QA005468002251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand