Individual
KAITLYN ROSE COUILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3117 SHORE DR, MARINETTE, WI 54143-4293
(715) 732-5111
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3203
WI
225200000X
Physical Therapy Assistant
5502007910
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100191537
—
WI
05
—
843324594
—
MI
Enumeration date
11/16/2021
Last updated
10/17/2024
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