Provider Demographics
NPI:1194225771
Name:FLORENSKI, KELLY ANN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:FLORENSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:KIRKUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7238
Practice Address - Street 1:106 S SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DAGGETT
Practice Address - State:MI
Practice Address - Zip Code:49821-8555
Practice Address - Country:US
Practice Address - Phone:906-753-2812
Practice Address - Fax:906-753-2716
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9620-24225100000X
MI5501010453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist