Provider Demographics
NPI:1275544082
Name:KOWALCZYK, MALGORZATA (LMT, PTA)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:GOSHA
Other - Middle Name:
Other - Last Name:KOWALCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT,PTA
Mailing Address - Street 1:5266 STATION WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3232
Mailing Address - Country:US
Mailing Address - Phone:561-809-5812
Mailing Address - Fax:
Practice Address - Street 1:5266 STATION WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3232
Practice Address - Country:US
Practice Address - Phone:561-809-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist