MEDICARE: MALGORZATA KOWALCZYK LMT, PTA

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	225700000X	Massage Therapist	MA52217	FL

General Provider Information

NPI Number	:	1275544082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALGORZATA KOWALCZYK LMT, PTA

Provider Business Mailing Address
First Line	:	5266 STATION WAY
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3232
Country	:	US
Telephone Number	:	561-809-5812
Fax Number	:

Provider Business Practice Location Address
First Line	:	5266 STATION WAY
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-3232
Country	:	US
Telephone Number	:	561-809-5812
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	05/10/2010

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