Provider Demographics
NPI:1598221947
Name:KLEUSKENS, JULIA R (DPT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:R
Last Name:KLEUSKENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:R
Other - Last Name:VANDE HEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1346 E GREEN BAY ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2210
Mailing Address - Country:US
Mailing Address - Phone:715-526-6244
Mailing Address - Fax:
Practice Address - Street 1:1346 E GREEN BAY ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2210
Practice Address - Country:US
Practice Address - Phone:715-526-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA296280OtherCA STATE LICENSE