Provider Demographics
NPI:1346343241
Name:KISIELEWSKI, STEPHANIE (RPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KISIELEWSKI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 CATTLERIDGE BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6014
Mailing Address - Country:US
Mailing Address - Phone:941-951-0706
Mailing Address - Fax:941-552-1429
Practice Address - Street 1:6050 CATTLERIDGE BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6014
Practice Address - Country:US
Practice Address - Phone:941-951-0706
Practice Address - Fax:941-552-1429
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884725800Medicaid
FLY4956OtherBC/BS
FL640076OtherPCA
FL884725800Medicaid