Individual
KATHRYN A BLASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
723 S WISCONSIN ST, PULASKI, WI 54162-9303
(920) 822-1100
(920) 822-5731
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11210-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11014110
—
WI
01
—
11210-024
WI LICENSE
WI
01
—
1851477913
CMH NPI
WI
01
—
390848401050
ANTHEM
WI
Enumeration date
08/05/2009
Last updated
05/26/2020
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