Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 13474-24 | WI |
NPI | 1003365313 |
---|---|
Provider Name | Michelle Keating |
First Address | Milwaukee, WI 53202-1230 |
Second Address | Wauwatosa, WI 53213-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |