MEDICARE: BRENDA LOUISE GAJOWSKI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	14336	NC

General Provider Information

NPI Number	:	1114943867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LOUISE GAJOWSKI DPT

Provider Business Mailing Address
First Line	:	5527 OPEN BOOK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3745
Country	:	US
Telephone Number	:	917-597-9192
Fax Number	:

Provider Business Practice Location Address
First Line	:	5527 OPEN BOOK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3745
Country	:	US
Telephone Number	:	917-597-9192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/25/2017

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