Provider Demographics
NPI:1376099218
Name:KLING, CARLY A (DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:A
Last Name:KLING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:A
Other - Last Name:GOELZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:725 S JANESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-1775
Mailing Address - Country:US
Mailing Address - Phone:608-868-5800
Mailing Address - Fax:608-868-5858
Practice Address - Street 1:725 S JANESVILLE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1775
Practice Address - Country:US
Practice Address - Phone:608-868-5800
Practice Address - Fax:608-868-5858
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13539-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist