Provider Demographics
NPI:1982013298
Name:KUJAWA, ERIC (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KUJAWA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N50W16002 MAPLE CREST LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-6644
Mailing Address - Country:US
Mailing Address - Phone:262-949-3907
Mailing Address - Fax:
Practice Address - Street 1:N50W16002 MAPLE CREST LN
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-6644
Practice Address - Country:US
Practice Address - Phone:262-949-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist