Individual
AMANDA KANACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(414) 672-1353
Mailing address
PO BOX 778789, CHICAGO, IL 60677-8789
(414) 672-1353
(262) 408-5094
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376026062
—
WI
Enumeration date
09/10/2018
Last updated
06/26/2023
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