Healthcare Provider Details

I. General information

NPI: 1174814834
Provider Name (Legal Business Name): KARI N ROEBBEKE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARI A NIETH

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 N 76TH ST
MILWAUKEE WI
53223-3914
US

IV. Provider business mailing address

3003 W GOOD HOPE RD
MILWAUKEE WI
53209-2042
US

V. Phone/Fax

Practice location:
  • Phone: 414-354-6434
  • Fax: 414-586-5745
Mailing address:
  • Phone: 414-352-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6343
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: