Provider Demographics
NPI:1902828890
Name:KLIEBHAN, LINDA A (PT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:KLIEBHAN
Suffix:
Gender:F
Credentials:PT
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-7410
Mailing Address - Fax:414-805-7499
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-7410
Practice Address - Fax:414-805-7499
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1902828890Medicaid
WI40007200Medicaid