KENNETH LISICKI

ORANGE PARK, FL
NPI1548352941
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: FL  PTA9633)
Enumeration Date2006-09-30
Last Update Date2007-07-08
Business Address
KENNETH LISICKI PTA
540 KINGSLEY AVE
ORANGE PARK, FL 32073-4847
Phone number: 904-264-2156
Mailing Address
KENNETH LISICKI PTA
235 CEZANNE CIR
SAINT AUGUSTINE, FL 32095-5017
Phone number: 904-728-2481
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