Provider Demographics
NPI:1407959711
Name:TENUTA, KAREN LYNNE (BS,PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNNE
Last Name:TENUTA
Suffix:
Gender:F
Credentials:BS,PT
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:LYNNE
Other - Last Name:HOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS,PT
Mailing Address - Street 1:7201 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3532
Mailing Address - Country:US
Mailing Address - Phone:262-694-3977
Mailing Address - Fax:262-694-5648
Practice Address - Street 1:7201 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3532
Practice Address - Country:US
Practice Address - Phone:262-694-3977
Practice Address - Fax:262-694-5648
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3540-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40190200Medicaid
WIP00338565OtherRAILROAD MEDICARE NUMBER
WI004485940Medicare ID - Type Unspecified