Healthcare Provider Details

I. General information

NPI: 1992916746
Provider Name (Legal Business Name): LORI M KUHN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 E CLIFFORD ST
PLYMOUTH WI
53073-2438
US

IV. Provider business mailing address

W7480 COUNTY ROAD V
CASCADE WI
53011-1231
US

V. Phone/Fax

Practice location:
  • Phone: 920-892-2654
  • Fax:
Mailing address:
  • Phone: 920-528-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number832-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: