MEDICARE: GREGORY J KLATKIEWICZ PTGCS

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	1295-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134141450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J KLATKIEWICZ PTGCS

Provider Business Mailing Address
First Line	:	12588 S PARK RD
Second Line	:
City	:	BUTTERNUT
State	:	WI
Zip	:	54514-8611
Country	:	US
Telephone Number	:	715-769-3322
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 LAWRENCE AVE
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1431
Country	:	US
Telephone Number	:	715-762-2449
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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