Provider Demographics
NPI:1821369091
Name:SERWATKA, MAREK (PT)
Entity Type:Individual
Prefix:MR
First Name:MAREK
Middle Name:
Last Name:SERWATKA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 PARKWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9345
Mailing Address - Country:US
Mailing Address - Phone:574-293-4512
Mailing Address - Fax:574-293-4513
Practice Address - Street 1:932 PARKWAY AVE STE B
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516
Practice Address - Country:US
Practice Address - Phone:574-293-4512
Practice Address - Fax:574-293-4513
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004733A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist