Provider Demographics
NPI:1972516102
Name:KOLLATH, BARBARA ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:KOLLATH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-4145
Mailing Address - Country:US
Mailing Address - Phone:414-771-5600
Mailing Address - Fax:414-476-9988
Practice Address - Street 1:6200 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-4145
Practice Address - Country:US
Practice Address - Phone:414-771-5600
Practice Address - Fax:414-476-9988
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI911-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist