Provider Demographics
NPI:1114313723
Name:KLOSIEWSKI, AMALIA (PTA)
Entity Type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:KLOSIEWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:KLOSIEWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:601 N BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-2959
Mailing Address - Country:US
Mailing Address - Phone:920-494-5231
Mailing Address - Fax:920-739-2103
Practice Address - Street 1:601 N BRIARCLIFF DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-2959
Practice Address - Country:US
Practice Address - Phone:920-494-5231
Practice Address - Fax:920-739-2103
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2209-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant