Healthcare Provider Details

I. General information

NPI: 1598686255
Provider Name (Legal Business Name): AHRA KO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 W MAIN ST STE 1
SUN PRAIRIE WI
53590-1922
US

IV. Provider business mailing address

1680 NYGAARD ST APT 328
STOUGHTON WI
53589-5441
US

V. Phone/Fax

Practice location:
  • Phone: 608-318-1357
  • Fax:
Mailing address:
  • Phone: 704-681-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: