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General NPI Number Information
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NPI Number | 1912632324
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Entity Type | Individual
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Provider Name | LOREN KRZYSKO PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 1411 OLIVER RD
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City | FAIRFIELD
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State | CA
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Zip | 94534-3424
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Country | US
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Telephone | 707-428-1311
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 W BLISSFUL DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-5062
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Country | US
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Telephone | 847-650-4069
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 4996
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License Number State | AR
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