Provider Demographics
NPI:1740462019
Name:KANKOLENSKI, DANA A (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:KANKOLENSKI
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 1:146 LYNDON ST
Mailing Address - Street 2:#5
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-5125
Mailing Address - Country:US
Mailing Address - Phone:310-698-0770
Mailing Address - Fax:310-698-0801
Practice Address - Street 1:1601 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3213
Practice Address - Country:US
Practice Address - Phone:310-698-0770
Practice Address - Fax:310-698-0801
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14125208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation