Individual
KELLIE KIDD-THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3613 S 13TH ST, SHEBOYGAN, WI 53081-7253
(920) 458-4040
Mailing address
432 N MILL STREET, APT. 209, SAUKVILLE, WI 53080
(262) 388-4448
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2593-19
WI
Other
Enumeration date
05/10/2017
Last updated
05/10/2017
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