Provider Demographics
NPI:1154608594
Name:CARR, KATHRYN A (PTA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:CARR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:JENKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 2119
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-2119
Mailing Address - Country:US
Mailing Address - Phone:715-479-7411
Mailing Address - Fax:
Practice Address - Street 1:201 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-8835
Practice Address - Country:US
Practice Address - Phone:715-356-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI960-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant