Provider Demographics
NPI:1437357407
Name:KORCZAK, DOROTA KATARZYNA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DOROTA
Middle Name:KATARZYNA
Last Name:KORCZAK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2112
Mailing Address - Country:US
Mailing Address - Phone:860-826-0188
Mailing Address - Fax:
Practice Address - Street 1:1157 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1600
Practice Address - Country:US
Practice Address - Phone:203-271-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist