Provider Demographics
NPI:1396002804
Name:PAWLOWSKI, PETER (CMT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E HENNEPIN AVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1030
Mailing Address - Country:US
Mailing Address - Phone:612-801-6887
Mailing Address - Fax:
Practice Address - Street 1:201 E HENNEPIN AVE
Practice Address - Street 2:SUITE #207
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1030
Practice Address - Country:US
Practice Address - Phone:612-801-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist