Provider Demographics
NPI:1194943936
Name:GULCZEWSKI, KEVIN RONALD (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RONALD
Last Name:GULCZEWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6327 LUCERNE ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6673
Mailing Address - Country:US
Mailing Address - Phone:561-743-2508
Mailing Address - Fax:561-743-0458
Practice Address - Street 1:6327 LUCERNE ST
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6673
Practice Address - Country:US
Practice Address - Phone:561-743-2508
Practice Address - Fax:561-743-0458
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9726AMedicare ID - Type UnspecifiedMEDICARE PART B SUPPLIER