MEDICARE: EWA GABRIELA GASIOROWSKI PT

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	05004646A	IN

General Provider Information

NPI Number	:	1750457065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EWA GABRIELA GASIOROWSKI PT

Provider Business Mailing Address
First Line	:	619 E SPRINGHILL DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4448
Country	:	US
Telephone Number	:	812-232-3504
Fax Number	:	812-232-6396

Provider Business Practice Location Address
First Line	:	619 E SPRINGHILL DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4448
Country	:	US
Telephone Number	:	812-232-3504
Fax Number	:	812-232-6396

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/11/2013

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