Provider Demographics
NPI:1477685865
Name:DUSIN, MITZI KIM (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:MITZI
Middle Name:KIM
Last Name:DUSIN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NEW LONDON TPKE
Mailing Address - Street 2:APT. E-10
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5448
Mailing Address - Country:US
Mailing Address - Phone:401-823-1275
Mailing Address - Fax:401-874-4804
Practice Address - Street 1:1800 NEW LONDON TPKE
Practice Address - Street 2:APT. E-10
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-5448
Practice Address - Country:US
Practice Address - Phone:401-823-1275
Practice Address - Fax:401-874-4804
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer