Provider Demographics
NPI:1326224619
Name:GAUL, MAREK JOZEF (PT)
Entity Type:Individual
Prefix:MR
First Name:MAREK
Middle Name:JOZEF
Last Name:GAUL
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 1:42732 TESSMER DRIVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS.
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3078
Mailing Address - Country:US
Mailing Address - Phone:586-739-5792
Mailing Address - Fax:586-228-7159
Practice Address - Street 1:16200 19 MILE RD.
Practice Address - Street 2:
Practice Address - City:CLINTON TWP.
Practice Address - State:MI
Practice Address - Zip Code:48038-1103
Practice Address - Country:US
Practice Address - Phone:586-416-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010062992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic