Healthcare Provider Details

I. General information

NPI: 1346740552
Provider Name (Legal Business Name): KYLE KLINZING PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N112W15237 MEQUON RD STE 500
GERMANTOWN WI
53022-3468
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-7834
  • Fax: 414-224-7835
Mailing address:
  • Phone: 630-590-4029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14048-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: