Individual
KIMBERLY ANN LANDSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, ATC
Contact information
Practice address
6810 W STATE ST, WAUWATOSA, WI 53213-2807
(414) 259-0623
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12596-24
WI
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
09/04/2009
Last updated
07/22/2014
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