Provider Demographics
NPI:1629016779
Name:ORLICZKY, KRISTINA MONNESS (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MONNESS
Last Name:ORLICZKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 COASTLINE DR
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5814
Mailing Address - Country:US
Mailing Address - Phone:562-715-2852
Mailing Address - Fax:562-431-3344
Practice Address - Street 1:1025 COASTLINE DR
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5814
Practice Address - Country:US
Practice Address - Phone:562-715-2852
Practice Address - Fax:562-431-3344
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18833OtherPHYSICAL THERAPY