Provider Demographics
NPI:1598995474
Name:KRAKOWSKI, LAUREEN KATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:KATHERINE
Last Name:KRAKOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 FANCY BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-6307
Mailing Address - Country:US
Mailing Address - Phone:912-996-5443
Mailing Address - Fax:
Practice Address - Street 1:212 FANCY BLUFF CIR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-6307
Practice Address - Country:US
Practice Address - Phone:912-996-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-25
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002390225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant