Provider Demographics
NPI:1174814834
Name:ROEBBEKE, KARI N (PT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:N
Last Name:ROEBBEKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:A
Other - Last Name:NIETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:7878 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-3914
Practice Address - Country:US
Practice Address - Phone:414-354-6434
Practice Address - Fax:414-586-5745
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI462364879Medicare PIN
WI019940654Medicare PIN