Provider Demographics
NPI:1538476536
Name:GRUSZECKA, AGNIESZKA M (LMT)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:M
Last Name:GRUSZECKA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 JO AN DR
Mailing Address - Street 2:STE 4
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4079
Mailing Address - Country:US
Mailing Address - Phone:941-228-4640
Mailing Address - Fax:
Practice Address - Street 1:2206 JO AN DR
Practice Address - Street 2:STE 4
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4079
Practice Address - Country:US
Practice Address - Phone:941-228-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist