Provider Demographics
NPI:1225005556
Name:STAWOWSKI, MARIUSZ (PT)
Entity Type:Individual
Prefix:MR
First Name:MARIUSZ
Middle Name:
Last Name:STAWOWSKI
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 1:702 JADWIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4256
Mailing Address - Country:US
Mailing Address - Phone:509-946-9007
Mailing Address - Fax:509-946-9755
Practice Address - Street 1:702 JADWIN AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4256
Practice Address - Country:US
Practice Address - Phone:509-946-9007
Practice Address - Fax:509-946-9755
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000086642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136021Medicaid
WA0195507OtherL&I
WA7603683OtherAETNA
WA0195507OtherL&I