Provider Demographics
NPI:1902557572
Name:WESTPHAL, KADIE MAE (DPT)
Entity type:Individual
Prefix:
First Name:KADIE
Middle Name:MAE
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KADIE
Other - Middle Name:M
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2105 E ENTERPRISE AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:920-560-1147
Mailing Address - Fax:920-991-2563
Practice Address - Street 1:212 E GREEN BAY ST STE A
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2472
Practice Address - Country:US
Practice Address - Phone:715-526-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist