Provider Demographics
NPI:1518032283
Name:PRONOWICZ, DENNIS R (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:PRONOWICZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-0261
Mailing Address - Country:US
Mailing Address - Phone:413-532-9913
Mailing Address - Fax:413-532-9054
Practice Address - Street 1:138 COLLEGE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1415
Practice Address - Country:US
Practice Address - Phone:413-532-9913
Practice Address - Fax:413-532-9054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65104OtherBLUECROSSBLUESHIELD
MA725535OtherTUFTSHEALTHPLAN
MA5780887OtherCIGNA
MA0335843Medicaid
MA725535OtherTUFTSHEALTHPLAN