MEDICARE: MRS. KATHLEEN JO SINCLAIR PT

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	3662-024	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	:	1700034436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN JO SINCLAIR PT

Provider Business Mailing Address
First Line	:	2654 N 97TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1650
Country	:	US
Telephone Number	:	414-475-7312
Fax Number	:

Provider Business Practice Location Address
First Line	:	2654 N 97TH ST
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-1650
Country	:	US
Telephone Number	:	414-475-7312
Fax Number	:

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

Provider Enumeration Date	:	09/06/2008
Last Update Date	:	09/06/2008

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