Individual
MS. KIMBERLY ELLEFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
10330 PRAIRIE RIDGE BLVD, PLEASANT PRAIRIE, WI 53158-1947
(262) 612-2856
(262) 612-2893
Mailing address
10330 PRAIRIE RIDGE BLVD, PLEASANT PRAIRIE, WI 53158-1947
(262) 612-2856
(262) 612-2893
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
150-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40360400
—
WI
Enumeration date
05/09/2008
Last updated
03/05/2015
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