Provider Demographics
NPI:1073663746
Name:KRECISZ, EWA (PT)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:KRECISZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 FOOTHILLS CENTER DR # 148150
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29696-2518
Mailing Address - Country:US
Mailing Address - Phone:864-638-6405
Mailing Address - Fax:
Practice Address - Street 1:148 FOOTHILLS CENTER DR # 148150
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696-2518
Practice Address - Country:US
Practice Address - Phone:864-638-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12437225100000X
IL070-009921225100000X
2251H1200X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
K06200Medicare UPIN
IL208912Medicare PIN