Provider Demographics
NPI:1043668502
Name:KUJAWA, LESLY (RTY200)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:KUJAWA
Suffix:
Gender:F
Credentials:RTY200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 IMPERIAL LN
Mailing Address - Street 2:YOGA BY PRESCRIPTION
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5925
Mailing Address - Country:US
Mailing Address - Phone:954-612-1100
Mailing Address - Fax:
Practice Address - Street 1:1340 SE 4TH CT
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4994
Practice Address - Country:US
Practice Address - Phone:954-612-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRYT#171772174400000X
FLRYT2002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174400000XOther Service ProvidersSpecialist