Provider Demographics
NPI:1790453538
Name:KOHLHAPP, CASSANDRA (PT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:KOHLHAPP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 E VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1660
Mailing Address - Country:US
Mailing Address - Phone:414-801-2867
Mailing Address - Fax:
Practice Address - Street 1:633 E MASON ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3813
Practice Address - Country:US
Practice Address - Phone:414-801-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist