Individual
IDA KOLODZIEJCZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
352 E HOOD AVE STE D, SISTERS, OR 97759-1619
(541) 904-4427
Mailing address
1441 SW CHANDLER AVE STE 103, BEND, OR 97702-3208
(541) 797-3052
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
64740
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64740
DPT
OR
Enumeration date
01/02/2023
Last updated
01/02/2023
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