Healthcare Provider Details

I. General information

NPI: 1346435617
Provider Name (Legal Business Name): MALGORZATA GRZYBOWSKA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 EVERGREEN KNOLL CT
ALEXANDRIA VA
22303-1056
US

IV. Provider business mailing address

5701 EVERGREEN KNOLL CT
ALEXANDRIA VA
22303-1056
US

V. Phone/Fax

Practice location:
  • Phone: 571-228-4210
  • Fax:
Mailing address:
  • Phone: 571-228-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number05791
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: