Individual
KYLIE COLWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
1250 S EVERGREEN ST, SHAWANO, WI 54166-3514
(715) 526-3107
Mailing address
370 LONGWOOD LN, WRIGHTSTOWN, WI 54180-1224
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4298-19
WI
Other
Enumeration date
08/22/2025
Last updated
08/22/2025
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