Provider Demographics
NPI:1730704594
Name:GAWELEK, KEEGAN (ATC, LAT, MAT)
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:GAWELEK
Suffix:
Gender:M
Credentials:ATC, LAT, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 LAKESHORE BLVD APT 623
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6914
Mailing Address - Country:US
Mailing Address - Phone:440-865-4496
Mailing Address - Fax:
Practice Address - Street 1:3750 CLEARY DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8542
Practice Address - Country:US
Practice Address - Phone:517-219-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer