Basic Information
Provider Information
NPI: 1003143389
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZEGAROWSKI
FirstName: BEATA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1292 QUANDT CT
Address2:  
City: LAFAYETTE
State: CA
PostalCode: 945492624
CountryCode: US
TelephoneNumber: 9252165047
FaxNumber:  
Practice Location
Address1: 1292 QUANDT CT
Address2:  
City: LAFAYETTE
State: CA
PostalCode: 945492624
CountryCode: US
TelephoneNumber: 9252165047
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/07/2009
LastUpdateDate: 11/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X18096CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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