MEDICARE: MRS. KRISTINA M TEBO PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1063124	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285716191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA M TEBO PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	2105 E ENTERPRISE AVE STE 113
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 MARINETTE AVE
Second Line	:
City	:	MARINETTE
State	:	WI
Zip	:	54143-3801
Country	:	US
Telephone Number	:	715-735-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/11/2025

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