Healthcare Provider Details

I. General information

NPI: 1689969990
Provider Name (Legal Business Name): MICHELLE KUZMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 W RIDGE RD
ERIE PA
16506-1213
US

IV. Provider business mailing address

4116 PAGE ST
ERIE PA
16510-3570
US

V. Phone/Fax

Practice location:
  • Phone: 814-836-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI002177
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: