Provider Demographics
NPI:1881675320
Name:GOSPODAREK, MARTA (PT)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:GOSPODAREK
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:432 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1462
Practice Address - Country:US
Practice Address - Phone:302-376-4315
Practice Address - Fax:302-376-4318
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3744644000OtherIBC
DE1881675320Medicaid
DE000050781OtherDPCI
DEP00707428OtherMEDICARE RR
DE1881675320Medicaid