Provider Demographics
NPI:1467483842
Name:CICHY, KENDRA L (DPT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:CICHY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:L
Other - Last Name:TURZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1439 CHURCHILL ST
Mailing Address - Street 2:STUITE 102
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2089
Mailing Address - Country:US
Mailing Address - Phone:715-258-7778
Mailing Address - Fax:715-258-7773
Practice Address - Street 1:1439 CHURCHILL ST
Practice Address - Street 2:STUITE 102
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2089
Practice Address - Country:US
Practice Address - Phone:715-258-7778
Practice Address - Fax:715-258-7773
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10658-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36116400Medicaid
WI000481379Medicare ID - Type Unspecified
WI001586160Medicare ID - Type Unspecified
WI001786015Medicare ID - Type Unspecified
WI36116400Medicaid