Basic Information
| Provider Information | |||||||||
| NPI: | 1295715548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURTZ | ||||||||
| FirstName: | ROSA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 175 | ||||||||
| Address2: | |||||||||
| City: | NORTHUMBERLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178570175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709880925 | ||||||||
| FaxNumber: | 5709880919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 NORMANDIE DR | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174081534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178499536 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | MD028769E | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0009943470006 | 05 | PA | MEDICAID |