Individual
MRS. NICOLE LEE KUSTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
310 W DEPOT ST, SILVER LAKE, WI 53170-1529
(262) 889-4925
Mailing address
310 W DEPOT ST, SILVER LAKE, WI 53170-1529
(262) 889-4925
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1089-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40396000
—
WI
Enumeration date
04/29/2008
Last updated
04/29/2008
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