Organization
KEYSTONE PHYSICAL THERAPY LLC
Active
Other names
KRC Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
AMY CARLSON (BUSINESS MANAGER)
(262) 790-5775
Entity
Organization
Contact information
Practice address
19265 W CAPITOL DR STE L01, BROOKFIELD, WI 53045-2740
(262) 790-5775
(262) 790-5710
Mailing address
19265 W CAPITOL DR STE L01, BROOKFIELD, WI 53045-2740
(262) 790-5775
(262) 790-5710
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
392031168010
ANTHEM BCBS
—
Enumeration date
02/01/2007
Last updated
08/05/2024
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