Healthcare Provider Details

I. General information

NPI: 1033575204
Provider Name (Legal Business Name): LEYLA KUZ-DWORZAK MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SUMMIT ST
HARTFORD CT
06106-3100
US

IV. Provider business mailing address

300 SUMMIT ST
HARTFORD CT
06106-3100
US

V. Phone/Fax

Practice location:
  • Phone: 860-297-4099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001095
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: