Provider Demographics
NPI:1629784038
Name:RUTKOWSKI, LURLEI KATRINA (LMT)
Entity Type:Individual
Prefix:
First Name:LURLEI
Middle Name:KATRINA
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MARSH RUN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-3113
Mailing Address - Country:US
Mailing Address - Phone:717-695-1485
Mailing Address - Fax:
Practice Address - Street 1:284 MARSH RUN RD
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-3113
Practice Address - Country:US
Practice Address - Phone:717-695-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG014559225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist