Provider Demographics
NPI:1538123914
Name:KURSZEWSKI, LORI SUZANNE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:LORI
Middle Name:SUZANNE
Last Name:KURSZEWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4296 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7825
Mailing Address - Country:US
Mailing Address - Phone:612-239-6330
Mailing Address - Fax:
Practice Address - Street 1:60 E. MARIE AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:612-239-6330
Practice Address - Fax:651-455-2766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer