Provider Demographics
NPI:1174571145
Name:JANKOWSKI, JERZY (PT)
Entity type:Individual
Prefix:
First Name:JERZY
Middle Name:
Last Name:JANKOWSKI
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 1:6960 DESTINY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2993
Mailing Address - Country:US
Mailing Address - Phone:916-630-8916
Mailing Address - Fax:916-630-8918
Practice Address - Street 1:6960 DESTINY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2993
Practice Address - Country:US
Practice Address - Phone:916-630-8916
Practice Address - Fax:916-630-8918
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP49855Medicare UPIN