Provider Demographics
NPI:1174679930
Name:CONTO, KEVIN MICHEAL (MPT,ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHEAL
Last Name:CONTO
Suffix:
Gender:M
Credentials:MPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 CATHERINE DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-1643
Mailing Address - Country:US
Mailing Address - Phone:262-997-4749
Mailing Address - Fax:
Practice Address - Street 1:9555 76TH ST
Practice Address - Street 2:SUITE 2620
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1984
Practice Address - Country:US
Practice Address - Phone:262-577-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6351024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist