Provider Demographics
NPI:1841950193
Name:RZESZUTKO, KIMBERLEY JANE
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:JANE
Last Name:RZESZUTKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 QUAIL HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1545
Mailing Address - Country:US
Mailing Address - Phone:214-226-0021
Mailing Address - Fax:
Practice Address - Street 1:10455 N CENTRAL EXPY STE 124
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2246
Practice Address - Country:US
Practice Address - Phone:214-226-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17023602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer