Provider Demographics
NPI:1477747327
Name:KLAIS, MARIANNE KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:KAY
Last Name:KLAIS
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 1:3137 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:STITZER
Mailing Address - State:WI
Mailing Address - Zip Code:53825-9781
Mailing Address - Country:US
Mailing Address - Phone:608-943-8538
Mailing Address - Fax:
Practice Address - Street 1:3137 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:STITZER
Practice Address - State:WI
Practice Address - Zip Code:53825-9781
Practice Address - Country:US
Practice Address - Phone:608-943-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3308-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist