Provider Demographics
NPI:1821561994
Name:ROGALSKI, IWONA WERONIKA (PTA,)
Entity Type:Individual
Prefix:
First Name:IWONA
Middle Name:WERONIKA
Last Name:ROGALSKI
Suffix:
Gender:F
Credentials:PTA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BAY 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4938
Mailing Address - Country:US
Mailing Address - Phone:347-702-9958
Mailing Address - Fax:
Practice Address - Street 1:153 BAY 26TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4938
Practice Address - Country:US
Practice Address - Phone:347-702-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010952225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant