Provider Demographics
NPI:1437343118
Name:KLITZKE, KIMBERLY MELISSA (MPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MELISSA
Last Name:KLITZKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4390 CROSSROADS CLINIC RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53952-9465
Mailing Address - Country:US
Mailing Address - Phone:608-589-5333
Mailing Address - Fax:608-589-5333
Practice Address - Street 1:N4390 CROSSROADS CLINIC RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:WI
Practice Address - Zip Code:53952
Practice Address - Country:US
Practice Address - Phone:608-589-5333
Practice Address - Fax:608-589-5388
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10065-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10065-024OtherSTATE PT LICENSE