Provider Demographics
NPI:1972046365
Name:MIERZEJEWSKI, KARA ELIZABETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ELIZABETH
Last Name:MIERZEJEWSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 S FLORIDA AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2184
Mailing Address - Country:US
Mailing Address - Phone:314-322-8507
Mailing Address - Fax:
Practice Address - Street 1:4525 S FLORIDA AVE STE 25
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2184
Practice Address - Country:US
Practice Address - Phone:863-812-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017024080225100000X
GACP014489T225100000X
FLPT388962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist