NPI 1073839056

Jacelyn Ann Marciniak, PTA

Practitioner Physical Therapy Assistant Kenosha, WI

Practice location

Address: 1519 60th St, Kenosha, WI 53140-3954
Phone: (262) 656-7500
Fax: (262) 656-7515
Mailing address: 4816 48th Ave, Kenosha, WI 53142

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence 1104-019 (WI)

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Registry record

NPI: 1073839056
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Apr 2010
Record last updated: 15 Apr 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.