Provider Demographics
NPI:1245542455
Name:CUKIERSKI, BRITTANY D (PT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:D
Last Name:CUKIERSKI
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 1:17100 E SHEA BLVD
Mailing Address - Street 2:225
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6625
Mailing Address - Country:US
Mailing Address - Phone:480-837-4565
Mailing Address - Fax:
Practice Address - Street 1:17100 E SHEA BLVD
Practice Address - Street 2:225
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6625
Practice Address - Country:US
Practice Address - Phone:480-837-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00943136OtherMEDICARE RAILROAD
ILP00943136OtherMEDICARE RAILROAD
IL216859233Medicare PIN