Provider Demographics
NPI:1275813461
Name:KEINERT, MALINDA MAY (DPT)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:MAY
Last Name:KEINERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W240N2566 E PARKWAY MEADOW CIR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5837
Mailing Address - Country:US
Mailing Address - Phone:920-207-3811
Mailing Address - Fax:
Practice Address - Street 1:3217 FIDDLERS CREEK DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3946
Practice Address - Country:US
Practice Address - Phone:262-896-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25846225100000X
WI12149-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK857ZMedicare PIN