Healthcare Provider Details

I. General information

NPI: 1396820718
Provider Name (Legal Business Name): SARA MILDRED SHULER RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

W204S10346 CINDY CRT
MUSKEGO WI
53150
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 262-679-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1080
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: