MEDICARE: AMY K KESTNER 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	174400000X	Specialist	2005005717	MO
2	208100000X	Physical Medicine & Rehabilitation Physician	12213-24	WI

General Provider Information

NPI Number	:	1861727729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY K KESTNER PT

Provider Business Mailing Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-387-8816
Fax Number	:	262-387-8843

Provider Business Practice Location Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-387-8816
Fax Number	:

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

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	07/15/2021

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