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NPI Code Detail

MEDICARE: KYRYL PRISICHENKO DPT

MEDICARE: KYRYL PRISICHENKO DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist306907CA

General Provider Information

NPI Number : 1083432108
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYRYL PRISICHENKO DPT
Provider Business Mailing Address
First Line : 3369 QUIGGLE AVE SE
Second Line :
City : ADA
State : MI
Zip : 49301-9291
Country : US
Telephone Number : 616-558-6701
Fax Number :
Provider Business Practice Location Address
First Line : 2550 N HOLLYWOOD WAY STE 100
Second Line :
City : BURBANK
State : CA
Zip : 91505-5015
Country : US
Telephone Number : 818-524-3730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2024
Last Update Date : 09/27/2024

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Directions to “ KYRYL PRISICHENKO DPT” Practice Location

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