Healthcare Provider Details

I. General information

NPI: 1124311923
Provider Name (Legal Business Name): KRISTINE J. LENKIEWICZ P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE J. NUCCIO P.T.

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HULSE RD
PT PLEASANT NJ
08742-4527
US

IV. Provider business mailing address

264 NOVELLO DR
BRICK NJ
08724-2064
US

V. Phone/Fax

Practice location:
  • Phone: 732-295-9300
  • Fax:
Mailing address:
  • Phone: 732-840-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00932700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: