Provider Demographics
NPI:1750457065
Name:GASIOROWSKI, EWA GABRIELA (PT)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:GABRIELA
Last Name:GASIOROWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EWA
Other - Middle Name:GABRIELA
Other - Last Name:WARDYGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 E SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4448
Mailing Address - Country:US
Mailing Address - Phone:812-232-3504
Mailing Address - Fax:812-232-6396
Practice Address - Street 1:619 E SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4448
Practice Address - Country:US
Practice Address - Phone:812-232-3504
Practice Address - Fax:812-232-6396
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004646A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist