Healthcare Provider Details

I. General information

NPI: 1134141450
Provider Name (Legal Business Name): GREGORY J KLATKIEWICZ PTGCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LAWRENCE AVE
PARK FALLS WI
54552-1431
US

IV. Provider business mailing address

12588 S PARK RD
BUTTERNUT WI
54514-8611
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2449
  • Fax:
Mailing address:
  • Phone: 715-769-3322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1295-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: