Individual
KENT CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPT
Contact information
Practice address
2835 N GRANDVIEW BLVD, SUITE 100, PEWAUKEE, WI 53072-5546
(262) 574-5185
(262) 574-5193
Mailing address
4240 S COVENTRY RD, NEW BERLIN, WI 53151-6145
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10398-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477719151
—
WI
Enumeration date
08/01/2008
Last updated
05/09/2011
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