Provider Demographics
NPI:1891021952
Name:ZASADNY, MALGORZATA (PT)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:
Last Name:ZASADNY
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 1:6072 BRYNWOOD DR
Mailing Address - Street 2:STE 102
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5829
Mailing Address - Country:US
Mailing Address - Phone:815-904-6163
Mailing Address - Fax:815-904-6516
Practice Address - Street 1:6072 BRYNWOOD DR
Practice Address - Street 2:STE 102
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5829
Practice Address - Country:US
Practice Address - Phone:815-904-6163
Practice Address - Fax:815-904-6516
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist