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General NPI Number Information
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NPI Number | 1407500101
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Entity Type | Individual
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Provider Name | ANDREA KIRCHENWITZ PTA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 220 HAVEN DR
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City | SHEBOYGAN FALLS
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State | WI
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Zip | 53085-3005
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Country | US
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Telephone | 920-467-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 NETWORK BLVD STE 102
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City | FRISCO
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State | TX
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Zip | 75034-9092
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Country | US
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Telephone | 877-825-8374
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3246-19
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License Number State | WI
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