Provider Demographics
NPI:1811003163
Name:SCHULISCH, KIMBERLY KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAY
Last Name:SCHULISCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3425 EXECUTIVE PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1326
Mailing Address - Country:US
Mailing Address - Phone:419-537-0764
Mailing Address - Fax:419-537-0948
Practice Address - Street 1:3234 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1398
Practice Address - Country:US
Practice Address - Phone:419-536-8030
Practice Address - Fax:419-536-8073
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT04939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist