Provider Demographics
NPI:1902815848
Name:LAHTI, KERRY L (MPT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:LAHTI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:L
Other - Last Name:MARQUARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 N PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8018
Mailing Address - Country:US
Mailing Address - Phone:920-257-2005
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:9675 E ELM RD
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:WI
Practice Address - Zip Code:54864-9102
Practice Address - Country:US
Practice Address - Phone:715-364-8565
Practice Address - Fax:715-364-8574
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9809-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI64-05466OtherMEDICA-POPLAR
WI40455700Medicaid
WIP00210715OtherRAILROAD MEDICARE
WV111196OtherSECURITY HEALTH PLAN
WI382K3LAOtherGROUP HEALTH/BCBS OF MN
WI64-05467OtherMEDICA-ASHLAND
WI40455700Medicaid