Provider Demographics
NPI:1174538557
Name:MIKULINSKY, MIKAYELA (PT)
Entity type:Individual
Prefix:
First Name:MIKAYELA
Middle Name:
Last Name:MIKULINSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12226 BOCA RESERVE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4622
Mailing Address - Country:US
Mailing Address - Phone:561-445-7956
Mailing Address - Fax:561-465-5192
Practice Address - Street 1:12226 BOCA RESERVE LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4622
Practice Address - Country:US
Practice Address - Phone:561-445-7956
Practice Address - Fax:561-465-5192
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16501225100000X
FL16501222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884400300Medicaid