Provider Demographics
NPI:1174705842
Name:KASPROWICZ, WOJCIECH D (PT)
Entity type:Individual
Prefix:MR
First Name:WOJCIECH
Middle Name:D
Last Name:KASPROWICZ
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 1:25100 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4910
Mailing Address - Country:US
Mailing Address - Phone:586-771-7440
Mailing Address - Fax:586-771-9966
Practice Address - Street 1:25100 KELLY RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4910
Practice Address - Country:US
Practice Address - Phone:586-771-7440
Practice Address - Fax:586-771-9966
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E021350OtherBCBS MI
MI0E021350OtherBLUE CARE NETWORK
MIOM52180Medicare PIN