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General NPI Number Information
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NPI Number | 1740963057
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Entity Type | Individual
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Provider Name | KARISA NICOLE GLOUDEMANS DPT
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | N2930 STATE ROAD 22
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City | WAUTOMA
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State | WI
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Zip | 54982-5267
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Country | US
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Telephone | 920-787-5030
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Fax | 920-787-5372
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Provider Business Mailing Address
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Address Line | W6641 RICKEY LN
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City | GREENVILLE
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State | WI
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Zip | 54942-8502
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Country | US
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Telephone | 920-419-4767
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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 | 16514-24
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License Number State | WI
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