Healthcare Provider Details

I. General information

NPI: 1518533561
Provider Name (Legal Business Name): MARTHA MARILYN KIEL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA MARILYN BRISCOE

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 N DOWNER AVE
MILWAUKEE WI
53211-4245
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 414-962-4400
  • Fax:
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15423-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: