Provider Demographics
NPI:1316190036
Name:GENNA, EMMANUELLE TWAROGOWSKI (PT)
Entity Type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:TWAROGOWSKI
Last Name:GENNA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMMANUELLE
Other - Middle Name:TWAROGOWSKI
Other - Last Name:TWAROGOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7620 SOUTHERN BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5667
Mailing Address - Country:US
Mailing Address - Phone:330-965-9330
Mailing Address - Fax:330-965-9308
Practice Address - Street 1:7620 SOUTHERN BLVD
Practice Address - Street 2:STE 3
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5667
Practice Address - Country:US
Practice Address - Phone:330-965-9330
Practice Address - Fax:330-965-9308
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22501225100000X
OHPT012720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist