MEDICARE: KAREN GVENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	814-019	WI

General Provider Information

NPI Number	:	1053355156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN GVENTER

Provider Business Mailing Address
First Line	:	W67N403 GRANT AVE
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2303
Country	:	US
Telephone Number	:	262-377-8078
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 E NEWPORT AVE
Second Line	:	COLUMBIA ST MARY'S HOSPITAL
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-0000
Country	:	US
Telephone Number	:	441-961-4164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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Directions to “ KAREN GVENTER ” Practice Location

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