Provider Demographics
NPI:1821761024
Name:CHMIELEWSKI, KAY CAROLYN (DPT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:CAROLYN
Last Name:CHMIELEWSKI
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 1:12101 W WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1049
Mailing Address - Country:US
Mailing Address - Phone:414-758-8922
Mailing Address - Fax:
Practice Address - Street 1:6220 S 108TH ST STE D
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2527
Practice Address - Country:US
Practice Address - Phone:414-533-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11009-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist