Provider Demographics
NPI:1417013871
Name:SADOWSKI, ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SADOWSKI
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-0671
Mailing Address - Country:US
Mailing Address - Phone:508-476-7113
Mailing Address - Fax:
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1967
Practice Address - Country:US
Practice Address - Phone:508-799-6538
Practice Address - Fax:508-799-5535
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3943677OtherAETNA CLAIMS #
MAAA25050OtherHARVARD PILGRIM PROVIDER
MA0700185Medicaid
MAY68410OtherBCBS PROVIDER #
MASA Y69431Medicare ID - Type UnspecifiedMEDICARE PROVIDER #