Individual
KELLY C FAGUNDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2345 CANTERBURY LN, SISTER BAY, WI 54234-5602
(920) 854-4111
Mailing address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 746-0410
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36107100
—
WI
Enumeration date
08/23/2006
Last updated
06/10/2025
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