Provider Demographics
NPI:1316181340
Name:KLAY, CARRIE JO (PTA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:KLAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6266
Mailing Address - Country:US
Mailing Address - Phone:920-889-0080
Mailing Address - Fax:
Practice Address - Street 1:440 WELLS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1409
Practice Address - Country:US
Practice Address - Phone:651-388-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA689225200000X
WI102-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant