Provider Demographics
NPI:1811208978
Name:KULIS, JOANNA M (PT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:KULIS
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 1:10825 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2906
Mailing Address - Country:US
Mailing Address - Phone:718-658-9700
Mailing Address - Fax:718-658-9703
Practice Address - Street 1:10825 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2906
Practice Address - Country:US
Practice Address - Phone:718-658-9700
Practice Address - Fax:718-658-9703
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0313951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist