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General NPI Number Information
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NPI Number | 1750154134
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Entity Type | Individual
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Provider Name | ADRIAN ELINGE KANGE PTA,CPT
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Gender | Male
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 1300 W SILVER SPRING DR
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City | GLENDALE
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State | WI
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Zip | 53209-4415
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Country | US
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Telephone | 414-228-8120
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Fax |
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Provider Business Mailing Address
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Address Line | N168W21850 MAIN ST APT 39
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City | JACKSON
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State | WI
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Zip | 53037-9395
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Country | US
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Telephone | 612-242-6173
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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 | A2871
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 4061
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License Number State | WI
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