Provider Demographics
NPI:1649352238
Name:KIJEWSKI, MICHELLE (MPT,CERT MDT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KIJEWSKI
Suffix:
Gender:F
Credentials:MPT,CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2601
Mailing Address - Country:US
Mailing Address - Phone:860-274-4092
Mailing Address - Fax:860-274-4099
Practice Address - Street 1:385 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2003
Practice Address - Country:US
Practice Address - Phone:203-453-2844
Practice Address - Fax:203-453-8772
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006844CT07OtherANTHEM BC BS
CT080006844CT06OtherANTHEM BC BS
CT080006844CT08OtherANTHEM BS BS