Individual
KRIS M MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
N30W23913 GREEN RD APT 7, PEWAUKEE, WI 53072-5766
(414) 426-3859
Mailing address
N30W23913 GREEN RD APT 7, PEWAUKEE, WI 53072-5766
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
492-19
WI
Other
Enumeration date
12/01/2017
Last updated
12/01/2017
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