Provider Demographics
NPI:1609022854
Name:KROLCZYK, KIM SUSANNE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:SUSANNE
Last Name:KROLCZYK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRANTLEY CT
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1547
Mailing Address - Country:US
Mailing Address - Phone:716-689-3156
Mailing Address - Fax:
Practice Address - Street 1:25 BRANTLEY CT
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1547
Practice Address - Country:US
Practice Address - Phone:716-689-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016232-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist