Individual
KALEB JOSEPH SANDELLCLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, DPT
Contact information
Practice address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16787
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100278649
—
WI
Enumeration date
04/30/2024
Last updated
08/15/2024
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