Individual
SHAD DJ KUKLEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
159 KERCHEVAL AVE, GROSSE POINTE FARMS, MI 48236-3610
(313) 640-2200
Mailing address
159 KERCHEVAL AVE, GROSSE POINTE FARMS, MI 48236-3610
(313) 640-2200
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502000445
MI
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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