Provider Demographics
NPI:1689841660
Name:LIPEIKA, KRISTINA J (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:J
Last Name:LIPEIKA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:J
Other - Last Name:KOROLUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-409-4595
Mailing Address - Fax:860-409-4860
Practice Address - Street 1:5 PEQUOT PARK RD
Practice Address - Street 2:LAKEBROOK MEDICAL CENTER SUITE 303
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1467
Practice Address - Country:US
Practice Address - Phone:860-399-6411
Practice Address - Fax:860-399-6822
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist