Basic Information
| Provider Information | |||||||||
| NPI: | 1609818921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAWLOWSKI | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 OLD ROUTE 7 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068041714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037400020 | ||||||||
| FaxNumber: | 2037750238 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 GROVE ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RIDGEFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068774114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034318471 | ||||||||
| FaxNumber: | 2034389543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004229 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00425943 | 05 | CT | MEDICAID |