Healthcare Provider Details

I. General information

NPI: 1922113083
Provider Name (Legal Business Name): KAREN ANN REZIN RKT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST 117F
TOMAH WI
54660-3105
US

IV. Provider business mailing address

8110 ENGLAND RD
TOMAH WI
54660-8587
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax:
Mailing address:
  • Phone: 608-372-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1057
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: