Provider Demographics
NPI:1679182596
Name:OSTERTAG, KRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:OSTERTAG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7885 490TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-7910
Mailing Address - Country:US
Mailing Address - Phone:715-495-7706
Mailing Address - Fax:
Practice Address - Street 1:1320 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1861
Practice Address - Country:US
Practice Address - Phone:715-386-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2458208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation