Provider Demographics
NPI:1659087120
Name:UKLEJA, KIRSTEN ANNE (PT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ANNE
Last Name:UKLEJA
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 1:508 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-2505
Mailing Address - Country:US
Mailing Address - Phone:309-360-0370
Mailing Address - Fax:
Practice Address - Street 1:1 ROCK ISLAND ARSENAL BLDG 110
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61299-5000
Practice Address - Country:US
Practice Address - Phone:866-524-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist