Healthcare Provider Details

I. General information

NPI: 1841591138
Provider Name (Legal Business Name): PAWEL TOMASZ GREDECKI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W MALONEY AVE STE 140
GALLUP NM
87301-3313
US

IV. Provider business mailing address

1300 W MALONEY AVE STE 140
GALLUP NM
87301-3313
US

V. Phone/Fax

Practice location:
  • Phone: 505-397-7560
  • Fax:
Mailing address:
  • Phone: 505-397-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3914
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: