Provider Demographics
NPI:1023625720
Name:MASLOWSKI, JOSEPH PETER (MT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:MASLOWSKI
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 FALL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3082
Mailing Address - Country:US
Mailing Address - Phone:817-676-3674
Mailing Address - Fax:
Practice Address - Street 1:6704 FALL MEADOW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3082
Practice Address - Country:US
Practice Address - Phone:817-676-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT131881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty