Provider Demographics
NPI:1669854881
Name:BEHL, KRISTEN EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:EMILY
Last Name:BEHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 MADISON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-3162
Mailing Address - Country:US
Mailing Address - Phone:920-568-9739
Mailing Address - Fax:920-568-9742
Practice Address - Street 1:1550 MADISON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-3162
Practice Address - Country:US
Practice Address - Phone:920-568-9739
Practice Address - Fax:920-568-9742
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13047024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist