Mark Tkaczuk

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

41686 Issued in CA

Practice address

5478 Wilshire Blvd Ste 208
Los Angeles, CA 90036-4225

Phone

(323) 936-7525

NPI assigned

Sep 16, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Body Rehab Center

  • Physical Therapist
  • Los Angeles, CA
  • NPI 1215153747
  NPD (past)

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410825600000",
    "number": "1740682269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5478 WILSHIRE BLVD STE 208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5478 WILSHIRE BLVD STE 208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364225",
            "telephone_number": "323-936-7525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TKACZUK",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-16",
        "last_updated": "2014-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "41686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Tizano, PNP
• Donna M. Tizenor-Tate
• Matthew Stephen Tjajadi, MD
• Talitha Chan Tjandra
• Jenny Tjauw, PHARM.D.
• TKMD Corp
• Everardo Tlahuel Jr.
• Karla Ines Tlatelpa Vazquez, MD
• Araceli Stephanie Tlatoa
• TLC Medical Supplies Inc

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, 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 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.