Healthcare Provider Details

I. General information

NPI: 1780942185
Provider Name (Legal Business Name): KIMBERLY A DZURINKO O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E MAIDEN ST
WASHINGTON PA
15301-4912
US

IV. Provider business mailing address

42 E MAIDEN ST
WASHINGTON PA
15301-4912
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-2228
  • Fax: 724-225-5746
Mailing address:
  • Phone: 724-225-2228
  • Fax: 724-225-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOC008636
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: