Individual
DIANE FLETCHER KLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3100
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40121600
—
WI
Enumeration date
06/16/2005
Last updated
09/29/2009
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