Provider Demographics
NPI:1083283816
Name:KADRLIK, WENDY KATE ROBERTS (PT/DPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KATE ROBERTS
Last Name:KADRLIK
Suffix:
Gender:F
Credentials:PT/DPT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT/DPT
Mailing Address - Street 1:445 STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:GRANTSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54840-7837
Mailing Address - Country:US
Mailing Address - Phone:715-463-2075
Mailing Address - Fax:715-463-2076
Practice Address - Street 1:445 STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:GRANTSBURG
Practice Address - State:WI
Practice Address - Zip Code:54840-7837
Practice Address - Country:US
Practice Address - Phone:715-463-2075
Practice Address - Fax:715-463-2076
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12287225100000X
WI15618.24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100182459Medicaid