Provider Demographics
NPI:1972118628
Name:SIKORSKAS, KYLIE RENEE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:RENEE
Last Name:SIKORSKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BEECH CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-1609
Mailing Address - Country:US
Mailing Address - Phone:570-660-3224
Mailing Address - Fax:
Practice Address - Street 1:529 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3029
Practice Address - Country:US
Practice Address - Phone:570-748-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012087261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation