Healthcare Provider Details

I. General information

NPI: 1417157645
Provider Name (Legal Business Name): KATHLEEN M FRENCH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840-7827
US

IV. Provider business mailing address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840-7827
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-5353
  • Fax: 715-463-7351
Mailing address:
  • Phone: 715-463-5353
  • Fax: 715-463-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3336
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: