Provider Demographics
NPI:1063646404
Name:BARANSKI, TOMASZ W (PT)
Entity Type:Individual
Prefix:MR
First Name:TOMASZ
Middle Name:W
Last Name:BARANSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6441 WOODHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7220
Mailing Address - Country:US
Mailing Address - Phone:317-839-5506
Mailing Address - Fax:
Practice Address - Street 1:1411 W COUNTY LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-5151
Practice Address - Country:US
Practice Address - Phone:317-886-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004228A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist