Provider Demographics
NPI:1164703641
Name:KRYSZEWSKI, IRMINA (P TA)
Entity Type:Individual
Prefix:
First Name:IRMINA
Middle Name:
Last Name:KRYSZEWSKI
Suffix:
Gender:F
Credentials:P TA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 VALARIA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-1723
Mailing Address - Country:US
Mailing Address - Phone:909-771-9810
Mailing Address - Fax:
Practice Address - Street 1:3195 VALARIA DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-1723
Practice Address - Country:US
Practice Address - Phone:909-771-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4554225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant