Provider Demographics
NPI:1124112909
Name:KIND, THERESA M (BS,PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:KIND
Suffix:
Gender:F
Credentials:BS,PT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:CESCATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, PT
Mailing Address - Street 1:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:262-898-8696
Practice Address - Street 1:15 W MILWAUKEE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2998
Practice Address - Country:US
Practice Address - Phone:877-552-2996
Practice Address - Fax:262-898-8696
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5035-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist