Provider Demographics
NPI:1104217926
Name:TEUTSCHMANN, KEVIN (ATC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:TEUTSCHMANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 MIRRO DR
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6746
Mailing Address - Country:US
Mailing Address - Phone:608-482-3166
Mailing Address - Fax:
Practice Address - Street 1:2424 MIRRO DR
Practice Address - Street 2:APARTMENT 5
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6746
Practice Address - Country:US
Practice Address - Phone:608-482-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1606-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer