Healthcare Provider Details

I. General information

NPI: 1760612279
Provider Name (Legal Business Name): DOMINIQUE MARIE KUZMA MPT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

IV. Provider business mailing address

1400 LOCUST ST
PITTSBURGH PA
15219-5114
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-4060
  • Fax:
Mailing address:
  • Phone: 412-232-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017741
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: