Provider Demographics
NPI:1962614644
Name:KLAS, SUSAN JO ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JO ANN
Last Name:KLAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5977 STATE ROAD 57
Mailing Address - Street 2:
Mailing Address - City:BELGIUM
Mailing Address - State:WI
Mailing Address - Zip Code:53004-9778
Mailing Address - Country:US
Mailing Address - Phone:920-994-4988
Mailing Address - Fax:
Practice Address - Street 1:1834 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2125
Practice Address - Country:US
Practice Address - Phone:414-933-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2008-09-24
Deactivation Date:2008-08-19
Deactivation Code:
Reactivation Date:2008-09-24
Provider Licenses
StateLicense IDTaxonomies
WI379 - 019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant