Provider Demographics
NPI:1730269663
Name:KACZYNSKI-CAJIGAS, SUSAN A (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:KACZYNSKI-CAJIGAS
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:PO BOX 15552
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-5552
Mailing Address - Country:US
Mailing Address - Phone:910-264-2643
Mailing Address - Fax:
Practice Address - Street 1:6611 DANTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3062
Practice Address - Country:US
Practice Address - Phone:910-452-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212105Medicaid