Provider Demographics
NPI:1831759059
Name:TRUSZKOWSKI, KEVIN WILLIAM (LMT (LICENSE MASS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:TRUSZKOWSKI
Suffix:
Gender:M
Credentials:LMT (LICENSE MASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 210
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-0210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:173 SHENKEL ROAD
Practice Address - Street 2:
Practice Address - City:EFFORT
Practice Address - State:PA
Practice Address - Zip Code:18330-9044
Practice Address - Country:US
Practice Address - Phone:610-217-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004969225700000X
NJ18KT00703900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist