Provider Demographics
NPI:1295271054
Name:TRZYNKA, THEODORE K (ATC)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:K
Last Name:TRZYNKA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 CONCORDIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5479
Mailing Address - Country:US
Mailing Address - Phone:651-641-8853
Mailing Address - Fax:651-641-8787
Practice Address - Street 1:1282 CONCORDIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5479
Practice Address - Country:US
Practice Address - Phone:651-641-8853
Practice Address - Fax:651-641-8787
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1521225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist