Healthcare Provider Details

I. General information

NPI: 1265984413
Provider Name (Legal Business Name): KAYLA SHARPEE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PARK AVE
COLUMBUS WI
53925-2402
US

IV. Provider business mailing address

1515 PARK AVE
COLUMBUS WI
53925-2402
US

V. Phone/Fax

Practice location:
  • Phone: 920-623-2200
  • Fax:
Mailing address:
  • Phone: 920-623-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13405-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number13405-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: