Provider Demographics
NPI:1871741298
Name:CIESLINSKI, ANNA M (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:CIESLINSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3153 GENUNG ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2929
Mailing Address - Country:US
Mailing Address - Phone:440-428-7072
Mailing Address - Fax:
Practice Address - Street 1:3153 GENUNG ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2929
Practice Address - Country:US
Practice Address - Phone:440-428-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA04521225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant