Provider Demographics
NPI:1730216649
Name:KAWEJSZA, JENEE MARIE (PT)
Entity type:Individual
Prefix:
First Name:JENEE
Middle Name:MARIE
Last Name:KAWEJSZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8813
Mailing Address - Country:US
Mailing Address - Phone:315-378-4260
Mailing Address - Fax:
Practice Address - Street 1:7455 MORGAN RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3956
Practice Address - Country:US
Practice Address - Phone:315-451-6767
Practice Address - Fax:315-451-0569
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4294Medicare PIN