=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093138026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FELICE KAWKA DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2014
-----------------------------------------------------
Last Update Date | 02/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10330 PRAIRIE RIDGE BLVD
-----------------------------------------------------
City | PLEASANT PRAIRIE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53158-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-612-2856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10330 PRAIRIE RIDGE BLVD
-----------------------------------------------------
City | PLEASANT PRAIRIE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53158-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-612-2856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1221936
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 12230-24
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------