Provider Demographics
NPI:1629265921
Name:KUKLENSKI, ELIZABETH ANNE (MPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:KUKLENSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 ANNAPOLIS RD
Mailing Address - Street 2:STE. 204
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1344
Mailing Address - Country:US
Mailing Address - Phone:410-551-0123
Mailing Address - Fax:410-551-0125
Practice Address - Street 1:1215 ANNAPOLIS RD
Practice Address - Street 2:STE. 204
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1344
Practice Address - Country:US
Practice Address - Phone:410-551-0123
Practice Address - Fax:410-551-0125
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD222562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic