Provider Demographics
NPI:1699977967
Name:TOMASZEWSKI, MAUREEN (PT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:TOMASZEWSKI
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 1:1242 6TH ST E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3024
Mailing Address - Country:US
Mailing Address - Phone:701-388-7592
Mailing Address - Fax:
Practice Address - Street 1:1207 PRAIRIE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3145
Practice Address - Country:US
Practice Address - Phone:701-356-0062
Practice Address - Fax:701-356-5412
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDTOM27042OtherBCBS PROVIDER NUMBER
ND58697Medicaid