Healthcare Provider Details

I. General information

NPI: 1790264307
Provider Name (Legal Business Name): JEREMY KUZNITZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11276 5TH ST STE 400
RANCHO CUCAMONGA CA
91730-0923
US

IV. Provider business mailing address

180 STONY ACRE DR
CRANSTON RI
02920-2103
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-0437
  • Fax:
Mailing address:
  • Phone: 508-308-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT309276
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT03126
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: