Individual
MRS. NICOLE C. BAILKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
6700 N. PORT WASHINGTON RD., ST. FRANCIS CHILDREN'S CENTER, GLENDALE, WI 53217-3919
(414) 351-8850
(414) 351-8846
Mailing address
6700 N. PORT WASHINGTON RD., C/O ST. FRANCIS CHILDREN'S CENTER, GLENDALE, WI 53217-3919
(414) 351-8850
(414) 351-8846
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
9966-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40405800
—
WI
Enumeration date
06/21/2006
Last updated
12/12/2011
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