Provider Demographics
NPI:1407809882
Name:KLUG, KIMBERLY BURNS (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BURNS
Last Name:KLUG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N52W16745 OAK RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0640
Mailing Address - Country:US
Mailing Address - Phone:262-783-1523
Mailing Address - Fax:
Practice Address - Street 1:1317 W GRAND AVE
Practice Address - Street 2:LAKE HILLS MEDICAL COMPLEX
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074
Practice Address - Country:US
Practice Address - Phone:262-284-2261
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5363-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist