Provider Demographics
NPI:1205227501
Name:KUJAWA, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:KUJAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LONE OAK LN
Mailing Address - Street 2:HARTFORD HEALTH CENTER
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2600
Mailing Address - Country:US
Mailing Address - Phone:262-670-1800
Mailing Address - Fax:262-836-1601
Practice Address - Street 1:110 LONE OAK LN
Practice Address - Street 2:HARTFORD HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2600
Practice Address - Country:US
Practice Address - Phone:262-670-1800
Practice Address - Fax:262-836-1601
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI371-392251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports