Provider Demographics
NPI:1659071215
Name:ZURIS, KALISA SUSANNE (PT)
Entity Type:Individual
Prefix:
First Name:KALISA
Middle Name:SUSANNE
Last Name:ZURIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 DUTCHESS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1707
Mailing Address - Country:US
Mailing Address - Phone:415-799-6083
Mailing Address - Fax:
Practice Address - Street 1:2 MILLBURY BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-1300
Practice Address - Country:US
Practice Address - Phone:508-859-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL26691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist