Provider Demographics
NPI:1598437006
Name:DZIUBINSKI, RHIANNON LEE (PTA)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:LEE
Last Name:DZIUBINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14990 LAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-9774
Mailing Address - Country:US
Mailing Address - Phone:574-850-6201
Mailing Address - Fax:
Practice Address - Street 1:820 FULMER RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-7006
Practice Address - Country:US
Practice Address - Phone:574-259-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003822A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant