Provider Demographics
NPI:1780345587
Name:GAJEWSKI, ERIC (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GAJEWSKI
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:ERIC SR.
Other - Middle Name:
Other - Last Name:GAJEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6767 W GREENFIELD AVE LOWR LEVEL3
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4967
Mailing Address - Country:US
Mailing Address - Phone:414-274-9621
Mailing Address - Fax:
Practice Address - Street 1:6767 W GREENFIELD AVE LOWR LEVEL3
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4967
Practice Address - Country:US
Practice Address - Phone:414-274-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist