Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1023577558 |
---|---|
Provider Name | Keara Thompson |
First Address | Franklin, WI 53132-7209 |
Second Address | Franklin, WI 53132-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |