Provider Demographics
NPI:1477611796
Name:ALDRICH, ANN KATHERINE (PT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:KATHERINE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MR
Other - First Name:ANN
Other - Middle Name:KATHERINE
Other - Last Name:MARX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1021 BAY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1799
Mailing Address - Country:US
Mailing Address - Phone:414-327-2829
Mailing Address - Fax:
Practice Address - Street 1:11035 W FOREST HOME AVE
Practice Address - Street 2:STE. 108
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2541
Practice Address - Country:US
Practice Address - Phone:414-529-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1162-024225100000X
2355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant