Individual
MRS. KIMBERLY L SLACK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 291-1066
(414) 291-1077
Mailing address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 291-1066
(414) 291-1077
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
890019
WI
Other
Enumeration date
06/03/2006
Last updated
07/08/2007
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