Provider Demographics
NPI:1881839769
Name:GRUSZCZYNSKI, MARIA NICHOLE (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:NICHOLE
Last Name:GRUSZCZYNSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 E DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2738
Mailing Address - Country:US
Mailing Address - Phone:559-285-8843
Mailing Address - Fax:559-570-0900
Practice Address - Street 1:7721 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0962
Practice Address - Country:US
Practice Address - Phone:559-439-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 35165OtherSTATE OF CALIFORNIA PHYSICAL THERAPY BOARD