Provider Demographics
NPI:1891959557
Name:MONTEMURRO, LUISA (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:LUISA
Middle Name:
Last Name:MONTEMURRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1957
Mailing Address - Country:US
Mailing Address - Phone:262-657-0222
Mailing Address - Fax:262-657-7190
Practice Address - Street 1:3601 30TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1695
Practice Address - Country:US
Practice Address - Phone:262-925-0311
Practice Address - Fax:262-657-0632
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11062-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0604410001OtherDMERC
WIP00851037OtherRAILROAD MEDICARE NUMBER
WI005185940Medicare PIN