Provider Demographics
NPI:1205291481
Name:KILCZEWSKI, KIERSTEN ELIZABETH (PT, DPT, CLT-LANA)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:ELIZABETH
Last Name:KILCZEWSKI
Suffix:
Gender:F
Credentials:PT, DPT, CLT-LANA
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:ELIZABETH
Other - Last Name:MARSHECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT-LANA
Mailing Address - Street 1:101 WALTER WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1210
Mailing Address - Country:US
Mailing Address - Phone:443-409-0051
Mailing Address - Fax:443-409-0058
Practice Address - Street 1:101 WALTER WARD BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1210
Practice Address - Country:US
Practice Address - Phone:443-409-0051
Practice Address - Fax:443-409-0058
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist