Provider Demographics
NPI:1871000893
Name:BRINKMAN, KATHRYN LAURA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LAURA
Last Name:BRINKMAN
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 1:5900 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2542
Mailing Address - Country:US
Mailing Address - Phone:414-429-1830
Mailing Address - Fax:
Practice Address - Street 1:9350 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1714
Practice Address - Country:US
Practice Address - Phone:414-797-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2599-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant