Individual
TIMOTHY JOSEPH KRUCHOWSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1500 45TH AVE STE B, GULFPORT, MS 39501-3714
(228) 864-1212
(228) 868-2323
Mailing address
12958 COLES CV, GULFPORT, MS 39503-5620
(228) 831-9480
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0843MS
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124330
—
MS
Enumeration date
08/28/2006
Last updated
07/08/2007
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