Provider Demographics
NPI:1831722008
Name:KLOTZKO, DAWN DELMONT (MS, PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DELMONT
Last Name:KLOTZKO
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:DELMONT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PT
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:UPPER JAY
Mailing Address - State:NY
Mailing Address - Zip Code:12987-0075
Mailing Address - Country:US
Mailing Address - Phone:518-946-7655
Mailing Address - Fax:
Practice Address - Street 1:75 PARK STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932
Practice Address - Country:US
Practice Address - Phone:518-873-6377
Practice Address - Fax:518-873-3097
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist