Individual
CHAD T MIKESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3601 30TH AVE, SUITE 103, KENOSHA, WI 53144-1695
(262) 657-7071
(262) 657-0632
Mailing address
600 OAKMONT LN STE 600C, WESTMONT, IL 60559-5548
(630) 575-6200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12437
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396186045
—
WI
Enumeration date
07/10/2013
Last updated
02/25/2019
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