Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3200 | WI |
NPI | 1083887269 |
---|---|
Provider Name | Mrs. Mary Kluth |
First Address | Sussex, WI 53089-4042 |
Second Address | Greenfield, WI 53220-4819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 08/04/2008 |