Provider Demographics
NPI:1093138026
Name:KAWKA, FELICE (DPT)
Entity Type:Individual
Prefix:DR
First Name:FELICE
Middle Name:
Last Name:KAWKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 PRAIRIE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1947
Mailing Address - Country:US
Mailing Address - Phone:262-612-2856
Mailing Address - Fax:
Practice Address - Street 1:10330 PRAIRIE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1947
Practice Address - Country:US
Practice Address - Phone:262-612-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221936225100000X
WI12230-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist