Provider Demographics
NPI:1215757224
Name:SAWRASEWICZ, AGNIESZKA MONIKA (MT)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:MONIKA
Last Name:SAWRASEWICZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 W WHITNEY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2956
Mailing Address - Country:US
Mailing Address - Phone:312-877-1600
Mailing Address - Fax:
Practice Address - Street 1:701 W MAIN ST # 3
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2643
Practice Address - Country:US
Practice Address - Phone:312-877-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist