Healthcare Provider Details

I. General information

NPI: 1760737779
Provider Name (Legal Business Name): LILAH JUDE KULAKOWSKI LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 PICCADILLY SQUARE DR SUITE A
MOBILE AL
36609-5103
US

IV. Provider business mailing address

6341 PICCADILLY SQUARE DR SUITE A
MOBILE AL
36609-5103
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5300
  • Fax: 251-343-6613
Mailing address:
  • Phone: 251-343-5300
  • Fax: 251-343-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1773
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: