Provider Demographics
NPI:1699214544
Name:KURZNOWSKI, MARYBETH (LMT)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:KURZNOWSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:POLLIONI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7449
Mailing Address - Country:US
Mailing Address - Phone:609-339-9207
Mailing Address - Fax:
Practice Address - Street 1:3 WALTON ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7449
Practice Address - Country:US
Practice Address - Phone:609-339-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00938000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist