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General NPI Number Information
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NPI Number | 1861985509
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Entity Type | Individual
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Provider Name | KRISTY JO DZIEWECZYNSKI PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 140 BUCHANAN ST N STE 150
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1640
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Country | US
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Telephone | 763-552-7733
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Fax |
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Provider Business Mailing Address
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Address Line | 2213 135TH ST
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City | NEW RICHMOND
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State | WI
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Zip | 54017-6136
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Country | US
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Telephone | 651-491-0065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14159-24
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License Number State | WI
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