Provider Demographics
NPI:1619261401
Name:DZURO, ELENA TERESE (CMT)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:TERESE
Last Name:DZURO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 MINNETONKA MILLS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5100
Mailing Address - Country:US
Mailing Address - Phone:952-933-3000
Mailing Address - Fax:952-930-3210
Practice Address - Street 1:11300 MINNETONKA MILLS RD
Practice Address - Street 2:SUITE C
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5100
Practice Address - Country:US
Practice Address - Phone:952-933-3000
Practice Address - Fax:952-930-3210
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 372600000X, 374U00000X
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide