Provider Demographics
NPI:1629640842
Name:LASIUK, MALGORZATA EWA (PTA)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:EWA
Last Name:LASIUK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MALGORZATA
Other - Middle Name:EWA
Other - Last Name:LASIUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:412 MICHAEL SEARS RD
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9218
Mailing Address - Country:US
Mailing Address - Phone:413-348-2454
Mailing Address - Fax:
Practice Address - Street 1:412 MICHAEL SEARS RD
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9218
Practice Address - Country:US
Practice Address - Phone:413-348-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7840225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant