Provider Demographics
NPI:1043237027
Name:KROGMAN, KENNETH JAMES (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:KROGMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 SHAGBARK CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5041
Mailing Address - Country:US
Mailing Address - Phone:608-239-2540
Mailing Address - Fax:
Practice Address - Street 1:6847 SHAGBARK CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5041
Practice Address - Country:US
Practice Address - Phone:608-239-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10191-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10191-24OtherPT