Basic Information
| Provider Information | |||||||||
| NPI: | 1609811736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAWICKA | ||||||||
| FirstName: | MARIOLA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 PEACHTREE CT | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HOLBROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117414616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314673700 | ||||||||
| FaxNumber: | 6314670928 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 WOODVALE RD | ||||||||
| Address2: | |||||||||
| City: | QUEENSBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128041785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187935556 | ||||||||
| FaxNumber: | 5187939863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 022077 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00022077 | 05 | NY | MEDICAID |