Healthcare Provider Details

I. General information

NPI: 1649452038
Provider Name (Legal Business Name): LAURIE KONTNEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S63W13644 JANESVILLE RD
MUSKEGO WI
53150-2713
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-0300
US

V. Phone/Fax

Practice location:
  • Phone: 414-427-5659
  • Fax: 414-427-1341
Mailing address:
  • Phone: 877-552-2996
  • Fax: 866-245-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3254-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: