Healthcare Provider Details

I. General information

NPI: 1467654012
Provider Name (Legal Business Name): JACQUELINE ANN KREZMIEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE ANN MILLER PT

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 N PENRYN RD
MANHEIM PA
17545-8562
US

IV. Provider business mailing address

513 MARGIN RD
LEBANON PA
17042-9105
US

V. Phone/Fax

Practice location:
  • Phone: 717-664-6350
  • Fax: 717-664-6382
Mailing address:
  • Phone: 717-273-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013665L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: