Provider Demographics
NPI:1023198991
Name:HAMMER, KATHRYN L (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:HAMMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:221 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53153-9617
Mailing Address - Country:US
Mailing Address - Phone:262-662-9760
Mailing Address - Fax:262-662-9761
Practice Address - Street 1:W231S7680 BIG BEND DR
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9686
Practice Address - Country:US
Practice Address - Phone:262-662-9760
Practice Address - Fax:262-662-9761
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5459-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1023198991Medicaid
WI000281066Medicare ID - Type UnspecifiedPHYSICAL THERAPIST