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Individual
JESSICA A WIATROWSKI
Active
Individual
JESSICA A WIATROWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
011595
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000113334
GHI HMO LEGACY#
NY
01
—
00011283007
UNIVERA LEGACY#
NY
01
—
000626050003
HEALTH NOW BCBS LEGACY#
NY
01
—
050301000137
FIDELIS LEGACY#
NY
05
—
08494418
—
NY
01
—
159888FT
PREFERRED CARE LEGACY#
NY
01
—
9390555
IHA LEGACY#
NY
Enumeration date
09/14/2006
Last updated
12/17/2010
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