Provider Demographics
NPI:1184681389
Name:KLUCINEC, BRIAN M (MSPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:KLUCINEC
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 NORTHEAST DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2755
Practice Address - Country:US
Practice Address - Phone:717-533-0215
Practice Address - Fax:717-533-0218
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012466L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50048730OtherCAPITAL BC
PA991848OtherPA BLUE SHIELD
PA025483R9XMedicare Oscar/Certification