Provider Demographics
NPI:1487315883
Name:WARSCHAWSKI-GONSHER, EVA C (PT)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:C
Last Name:WARSCHAWSKI-GONSHER
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 1:2408 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9199 REISTERSTOWN RD STE 101B
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:MD
Practice Address - Zip Code:21117-4513
Practice Address - Country:US
Practice Address - Phone:443-898-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22345OtherMD PT LICENSE