Provider Demographics
NPI:1639646169
Name:KRUSZELNICKI, MISSY A (PTA)
Entity type:Individual
Prefix:
First Name:MISSY
Middle Name:A
Last Name:KRUSZELNICKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:ANN
Other - Last Name:FRIOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:813 FAY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3009
Mailing Address - Country:US
Mailing Address - Phone:315-561-6011
Mailing Address - Fax:
Practice Address - Street 1:61 DELANO ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:NY
Practice Address - Zip Code:13142-1400
Practice Address - Country:US
Practice Address - Phone:315-298-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011763-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant