MEDICARE: KURT ALT PT

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	2540-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891711008	OTHER	WI	CLINIC NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194879270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT ALT PT

Provider Business Mailing Address
First Line	:	701 E CARLISLE AVE
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53217-4835
Country	:	US
Telephone Number	:	414-963-9850
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 N GLEN PARK RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4403
Country	:	US
Telephone Number	:	414-351-8888
Fax Number	:	414-351-5219

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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Directions to “ KURT ALT PT” Practice Location

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