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General NPI Number Information
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NPI Number | 1043668502
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Entity Type | Individual
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Provider Name | LESLY KUJAWA RTY200
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Gender | Female
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 1340 SE 4TH CT
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City | DEERFIELD BEACH
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State | FL
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Zip | 33441-4994
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Country | US
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Telephone | 954-612-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 232 IMPERIAL LN YOGA BY PRESCRIPTION
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City | LAUDERDALE BY THE SEA
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State | FL
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Zip | 33308-5925
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Country | US
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Telephone | 954-612-1100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | RYT#171772
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RYT200
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License Number State | FL
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