Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 11877 | WI |
N | 2251S0007X | Physical Therapist - Sports | 11877 | WI |
NPI | 1255729901 |
---|---|
Provider Name | Kaitlin Hong |
First Address | Milwaukee, WI 53227-4161 |
Second Address | Milwaukee, WI 53227-4161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2015 |
Last Update Date | 25/01/2020 |