Provider Demographics
NPI:1447958012
Name:KLIMAS, MIKAYLA LEE
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LEE
Last Name:KLIMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 LOCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARDING
Mailing Address - State:PA
Mailing Address - Zip Code:18643-3012
Mailing Address - Country:US
Mailing Address - Phone:570-881-2870
Mailing Address - Fax:
Practice Address - Street 1:824 MCAPLINE ST ST STE 5
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641
Practice Address - Country:US
Practice Address - Phone:570-471-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist