Provider Demographics
NPI:1679834576
Name:KURZAWA, EMILY RAEANN (LMP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RAEANN
Last Name:KURZAWA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 S WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4442
Mailing Address - Country:US
Mailing Address - Phone:509-845-9335
Mailing Address - Fax:
Practice Address - Street 1:3001 W 10TH AVE
Practice Address - Street 2:A101
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5019
Practice Address - Country:US
Practice Address - Phone:509-737-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60282127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist