Provider Demographics
NPI:1063433134
Name:KRUZYNSKI, VICTORIA JEAN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JEAN
Last Name:KRUZYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 MILLERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49759-9785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6559 MILLERSBURG RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:MI
Practice Address - Zip Code:49759-9785
Practice Address - Country:US
Practice Address - Phone:989-733-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP20620001Medicare PIN