Provider Demographics
NPI:1457561763
Name:KULAK, MICHELINA CASSELLA (PT)
Entity Type:Individual
Prefix:
First Name:MICHELINA
Middle Name:CASSELLA
Last Name:KULAK
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:FARLEY 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02211-0001
Mailing Address - Country:US
Mailing Address - Phone:617-355-7223
Mailing Address - Fax:617-730-0151
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FARLEY 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02211-0001
Practice Address - Country:US
Practice Address - Phone:617-355-7223
Practice Address - Fax:617-730-0151
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11462251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics