Provider Demographics
NPI:1629374376
Name:LISZKA, KATHLEEN KUBIK (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:KUBIK
Last Name:LISZKA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:CAROL
Other - Last Name:KUBIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1164 DURYEA DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-6821
Mailing Address - Country:US
Mailing Address - Phone:717-566-3635
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011860L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist