Provider Demographics
NPI:1760269492
Name:GASIOR, KAROL PETER (DPT)
Entity Type:Individual
Prefix:
First Name:KAROL
Middle Name:PETER
Last Name:GASIOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 WATERS EDGE
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648
Mailing Address - Country:US
Mailing Address - Phone:231-329-3886
Mailing Address - Fax:
Practice Address - Street 1:3899 W FRONT ST STE 3
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8104
Practice Address - Country:US
Practice Address - Phone:231-944-6541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist