Healthcare Provider Details

I. General information

NPI: 1538362009
Provider Name (Legal Business Name): ALAN JAMES KUKLINSKI M. P. T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 EAST AVE
ERIE PA
16507-1842
US

IV. Provider business mailing address

136 EAST AVE
ERIE PA
16507-1842
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-7661
  • Fax: 814-455-1132
Mailing address:
  • Phone: 814-453-7661
  • Fax: 814-455-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-010854-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: