Provider Demographics
NPI:1073716031
Name:CLOVER, KAREN T (PHYSICAL THERAPY ASS)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:T
Last Name:CLOVER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY ASS
Other - Prefix:
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Mailing Address - Street 1:3748 N 97 PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222
Mailing Address - Country:US
Mailing Address - Phone:414-463-2461
Mailing Address - Fax:
Practice Address - Street 1:19525 W NORTH AVENUE
Practice Address - Street 2:FRANCISCAN WOODS
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-785-1114
Practice Address - Fax:262-780-3805
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
785019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant