Provider Demographics
NPI:1497091482
Name:ZAWISLAK, GRZEGORZ (PT)
Entity Type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:
Last Name:ZAWISLAK
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 1:2055 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0327
Mailing Address - Country:US
Mailing Address - Phone:313-740-2672
Mailing Address - Fax:248-967-2266
Practice Address - Street 1:2055 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-0327
Practice Address - Country:US
Practice Address - Phone:313-740-2672
Practice Address - Fax:248-967-2266
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist