Provider Demographics
NPI:1194934604
Name:KLEIN, KATIE C (PT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:C
Other - Last Name:BANACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S68W13407 BRISTLECONE LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-3331
Mailing Address - Country:US
Mailing Address - Phone:414-858-0332
Mailing Address - Fax:
Practice Address - Street 1:6737 W WASHINGTON ST STE 3200
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5651
Practice Address - Country:US
Practice Address - Phone:414-607-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9883-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist