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
State | License ID | Taxonomies |
---|---|---|
MA | 1886 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | Y65104 | Other | BLUECROSSBLUESHIELD |
MA | 725535 | Other | TUFTSHEALTHPLAN |
MA | 5780887 | Other | CIGNA |
MA | 0335843 | Medicaid | |
MA | 725535 | Other | TUFTSHEALTHPLAN |