Provider Demographics
NPI:1164079927
Name:SZYCHOWSKI, KEVIN D (PT, MPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:SZYCHOWSKI
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SAINT JAMES ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1315
Mailing Address - Country:US
Mailing Address - Phone:570-301-7336
Mailing Address - Fax:
Practice Address - Street 1:25 SAINT JAMES ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1315
Practice Address - Country:US
Practice Address - Phone:570-301-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25259225100000X
PAPT019676208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty