Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2878 | AZ |
NPI | 1043698376 |
---|---|
Provider Name | Dr. Mary Kruchowsky |
First Address | Kennett Square, PA 19348-3109 |
Second Address | Kennett Square, PA 19348-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z15073 | MEDICARE IDENTIFICATION NUMBER - (PTAN) (01) | AZ |