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General NPI Number Information
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NPI Number | 1295788545
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Entity Type | Individual
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Provider Name | KRISTIN MARIE ETZELMUELLER P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | N54 MILL STREET SUITE 101
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City | CEDARBURG
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State | WI
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Zip | 53012
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Country | US
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Telephone | 262-376-3040
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Fax | 262-376-3042
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Provider Business Mailing Address
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Address Line | W71N452 MULBERRY AVE
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City | CEDARBURG
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State | WI
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Zip | 53012-2273
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Country | US
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Telephone | 262-375-7041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4047
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License Number State | WI
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