Provider Demographics
NPI:1902165657
Name:RADZIK, CARRIE (ATC/L, LMT, NMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:RADZIK
Suffix:
Gender:F
Credentials:ATC/L, LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 ADAMS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-9173
Mailing Address - Country:US
Mailing Address - Phone:419-497-2112
Mailing Address - Fax:419-497-2114
Practice Address - Street 1:8081 ADAMS RIDGE RD
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9173
Practice Address - Country:US
Practice Address - Phone:419-497-2112
Practice Address - Fax:419-497-2114
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist