Provider Demographics
NPI:1164491908
Name:WEBSKOWSKI, GARY DAVID (MPT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:DAVID
Last Name:WEBSKOWSKI
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4800
Mailing Address - Country:US
Mailing Address - Phone:952-806-5619
Mailing Address - Fax:952-806-5510
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-806-5619
Practice Address - Fax:952-806-5510
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
059G6WEOtherBCBS
104667OtherUCARE
6090OtherMN STATE LICENSE
6576528OtherAOA ST TAX
989211040352OtherPREFERRED ONE
HP40440OtherHEALTH PARTNERS
411239729OtherFEDERAL TAX
30701054OtherPRIMWEST BILLING
6404578OtherMEDICA
138399200OtherACS PROV
P00082826OtherTRAVELERS MEDICARE
P00082826OtherTRAVELERS MEDICARE