Healthcare Provider Details

I. General information

NPI: 1073038162
Provider Name (Legal Business Name): KATHRYN GEROULIS HENSCHEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 N 6TH ST
MILWAUKEE WI
53212-3360
US

IV. Provider business mailing address

10473 S GEORGE DR
OAK CREEK WI
53154-6541
US

V. Phone/Fax

Practice location:
  • Phone: 414-978-9100
  • Fax:
Mailing address:
  • Phone: 262-880-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6316-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: