Healthcare Provider Details

I. General information

NPI: 1790264307
Provider Name (Legal Business Name): JEREMY KUZNITZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CENTERVILLE RD FL 2
WARWICK RI
02886-4394
US

IV. Provider business mailing address

4 RICHMOND SQ STE 200
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 401-726-7100
  • Fax: 401-732-8230
Mailing address:
  • Phone: 401-726-7100
  • Fax: 401-433-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT03126
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: