Tiffany Lorraine Waniczek-Nowicki

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

295589 Issued in CA

Practice address

200 E del Mar Blvd Ste 302
Pasadena, CA 91105-2552

Phone

(626) 683-8536

NPI assigned

Sep 24, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tiffany Lorraine Waniczek Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evergreen Physical Therapy Specialists, Inc

  • Physical Therapy Clinic/Center
  • Pasadena, CA
  • NPI 1346300670

  Multi-Specialty

  Medicare reassignment NPD
• New Life Physical Therapy Services, PC

  • Physical Therapist
  • Beverly Hills, CA
  • NPI 1285160788

  Multi-Specialty

  Medicare reassignment NPD
• Foothill Family Service - Hudson

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pasadena, CA
  • NPI 1336275056
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537747200000",
    "number": "1013491117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E DEL MAR BLVD STE 302",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E DEL MAR BLVD STE 302",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911052552",
            "telephone_number": "626-683-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANICZEK-NOWICKI",
        "first_name": "TIFFANY",
        "middle_name": "LORRAINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-24",
        "last_updated": "2018-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "295589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "WANICZEK",
            "middle_name": "LORRAINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wei CHI Wang
• Winnie Chan Wang
• Xiaoxiao Wang, FNP-C
• Xuedong Wang, MD
• Yonghai Wang
• Warby Parker Inc.
• Andrette T Ward
• Michael F Ward II, DO
• Rachel Ward, LMFT
• Sandra I Warf, BA

• Physical Therapist in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.