Provider Demographics
NPI:1437038965
Name:HRYNIEWICKI, JARED
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:HRYNIEWICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18732 COACHMANS TRCE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8122
Mailing Address - Country:US
Mailing Address - Phone:727-564-6804
Mailing Address - Fax:
Practice Address - Street 1:1417 WILKESBORO HWY
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-3262
Practice Address - Country:US
Practice Address - Phone:704-450-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP24238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty