Provider Demographics
NPI:1548215155
Name:WALBRUN, SUSAN KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:WALBRUN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:KOSIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5320 W MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8446
Mailing Address - Country:US
Mailing Address - Phone:920-882-8200
Mailing Address - Fax:
Practice Address - Street 1:5320 W MICHAELS DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8446
Practice Address - Country:US
Practice Address - Phone:920-882-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40217900Medicaid
WI00381160Medicare ID - Type Unspecified