Provider Demographics
NPI:1689928152
Name:KLICHINSKY, LEONID (DPT)
Entity Type:Individual
Prefix:DR
First Name:LEONID
Middle Name:
Last Name:KLICHINSKY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 SHELLEY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2343
Mailing Address - Country:US
Mailing Address - Phone:267-249-0877
Mailing Address - Fax:215-914-9073
Practice Address - Street 1:3876 SHELLEY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-2343
Practice Address - Country:US
Practice Address - Phone:267-647-9097
Practice Address - Fax:215-914-9073
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0212132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1234Other1234