Provider Demographics
NPI:1427640614
Name:KALINOSKI, LAKIN E (PTA)
Entity type:Individual
Prefix:
First Name:LAKIN
Middle Name:E
Last Name:KALINOSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SPORTSMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-6607
Mailing Address - Country:US
Mailing Address - Phone:814-525-4350
Mailing Address - Fax:
Practice Address - Street 1:303 SPORTSMAN RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-6607
Practice Address - Country:US
Practice Address - Phone:814-525-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant