Provider Demographics
NPI:1194879270
Name:ALT, KURT (PT)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:ALT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4835
Mailing Address - Country:US
Mailing Address - Phone:414-963-9850
Mailing Address - Fax:
Practice Address - Street 1:5750 N GLEN PARK RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4403
Practice Address - Country:US
Practice Address - Phone:414-351-8888
Practice Address - Fax:414-351-5219
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2540-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891711008OtherCLINIC NPI
WI40116400Medicaid