Provider Demographics
NPI:1861985509
Name:DZIEWECZYNSKI, KRISTY JO (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:JO
Last Name:DZIEWECZYNSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:JO
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2213 135TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-6136
Mailing Address - Country:US
Mailing Address - Phone:651-491-0065
Mailing Address - Fax:
Practice Address - Street 1:140 BUCHANAN ST N STE 150
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1640
Practice Address - Country:US
Practice Address - Phone:763-552-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14159-24225100000X
COPTL.0015695261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy