Provider Demographics
NPI:1558125971
Name:KEHLER, MADELINE (PT)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KEHLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:MEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 E ENTERPRISE AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:920-560-1083
Mailing Address - Fax:920-560-1083
Practice Address - Street 1:145 N COMMERCIAL ST STE 100
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3005
Practice Address - Country:US
Practice Address - Phone:920-215-6225
Practice Address - Fax:920-215-3947
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16626-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty