MEDICARE: DR. KATELYN MAYDANIUK DPT

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	225100000X	Physical Therapist	1508624	WI

General Provider Information

NPI Number	:	1104434182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATELYN MAYDANIUK DPT

Provider Business Mailing Address
First Line	:	10930 W POTTER RD STE C
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3450
Country	:	US
Telephone Number	:	414-400-6556
Fax Number	:	414-400-6557

Provider Business Practice Location Address
First Line	:	10930 W POTTER RD STE C
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3450
Country	:	US
Telephone Number	:	414-400-6556
Fax Number	:	414-400-6557

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	05/07/2024

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