Provider Demographics
NPI:1760680821
Name:SEWCZAK-CLAUDE, GRETCHEN MARY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:MARY
Last Name:SEWCZAK-CLAUDE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:MARY
Other - Last Name:CLAUDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4111 BOBOLINK LN
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5525
Mailing Address - Country:US
Mailing Address - Phone:303-319-3803
Mailing Address - Fax:
Practice Address - Street 1:3125 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5137
Practice Address - Country:US
Practice Address - Phone:307-742-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
066600Medicare Oscar/Certification