Provider Demographics
NPI:1528271913
Name:STRUZINSKY, SHAWN THOMAS (PTA)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:THOMAS
Last Name:STRUZINSKY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9103
Mailing Address - Country:US
Mailing Address - Phone:989-798-3883
Mailing Address - Fax:
Practice Address - Street 1:2189 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9103
Practice Address - Country:US
Practice Address - Phone:989-798-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant