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NPI Code Detail

MEDICARE: ANGELA L KLISZ DPT

MEDICARE: ANGELA L KLISZ DPT
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
1225100000XPhysical Therapist13635WI
2225100000XPhysical Therapist070013810IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11619980OTHERILBCBS OF IL
2367885100OTHERILUS DEPT OF LABOR
31623066OTHERILBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1336164177
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA L KLISZ DPT
Provider Business Mailing Address
First Line : 21075 SWENSON DR
Second Line : STE 600
City : WAUKESHA
State : WI
Zip : 53186-2062
Country : US
Telephone Number : 312-640-0329
Fax Number :
Provider Business Practice Location Address
First Line : 360 STATION DR
Second Line : SUITE 250
City : CRYSTAL LAKE
State : IL
Zip : 60014-7978
Country : US
Telephone Number : 815-356-1750
Fax Number : 815-356-1755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 06/07/2018

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Directions to “ ANGELA L KLISZ DPT” Practice Location

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