Provider Demographics
NPI:1346435617
Name:GRZYBOWSKA, MALGORZATA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MALGORZATA
Middle Name:
Last Name:GRZYBOWSKA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 EVERGREEN KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1056
Mailing Address - Country:US
Mailing Address - Phone:571-228-4210
Mailing Address - Fax:
Practice Address - Street 1:5701 EVERGREEN KNOLL CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1056
Practice Address - Country:US
Practice Address - Phone:571-228-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05791171W00000X
VA171W00000X
DC171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor