Individual
KENNETH LISICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
540 KINGSLEY AVE, ORANGE PARK, FL 32073-4847
(904) 264-2156
Mailing address
235 CEZANNE CIR, SAINT AUGUSTINE, FL 32095-5017
(904) 728-2481
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA9633
FL
Other
Enumeration date
09/30/2006
Last updated
07/08/2007
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