Provider Demographics
NPI:1902519424
Name:SULEWSKI, KARSYN BRIANA (PTA)
Entity Type:Individual
Prefix:
First Name:KARSYN
Middle Name:BRIANA
Last Name:SULEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KARSYN
Other - Middle Name:BRIANA
Other - Last Name:CORNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3310 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1618
Mailing Address - Country:US
Mailing Address - Phone:254-246-1299
Mailing Address - Fax:
Practice Address - Street 1:16044 COUNTY ROAD 165
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-7302
Practice Address - Country:US
Practice Address - Phone:254-246-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2131357208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation