Individual
MRS. KELLIE RAE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2626 N 76TH ST, WAUWATOSA, WI 53213-1137
(414) 774-7794
Mailing address
2626 N 76TH ST, WAUWATOSA, WI 53213-1137
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12676-24
WI
Other
Enumeration date
01/11/2016
Last updated
01/05/2022
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