Provider Demographics
NPI:1780319517
Name:CZARNECKI, MARIE JEANNETTE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:JEANNETTE
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 MISTY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3653
Mailing Address - Country:US
Mailing Address - Phone:860-502-7976
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN ST # A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2985
Practice Address - Country:US
Practice Address - Phone:860-674-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23960225100000X
CT11908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist