Healthcare Provider Details

I. General information

NPI: 1568505097
Provider Name (Legal Business Name): PAUL JOSEPH KRUNICH RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 DIMARCO RD
TAMPA FL
33634-7310
US

IV. Provider business mailing address

6406 DIMARCO RD
TAMPA FL
33634-7310
US

V. Phone/Fax

Practice location:
  • Phone: 813-884-3766
  • Fax:
Mailing address:
  • Phone: 813-884-3766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT0002744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: