Provider Demographics
NPI:1265450803
Name:KULCZYCKI, AMY (ATC, CSCS)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:KULCZYCKI
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 POMONA DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1857
Mailing Address - Country:US
Mailing Address - Phone:217-390-4877
Mailing Address - Fax:
Practice Address - Street 1:200 S SHELDON ST
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-2431
Practice Address - Country:US
Practice Address - Phone:217-892-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer