Provider Demographics
NPI:1205170404
Name:CHILBERT, MARIA K (DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:K
Last Name:CHILBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3360
Mailing Address - Country:US
Mailing Address - Phone:414-978-9100
Mailing Address - Fax:414-978-9139
Practice Address - Street 1:1271 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3360
Practice Address - Country:US
Practice Address - Phone:414-978-9100
Practice Address - Fax:414-978-9139
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12219-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1205170404Medicaid
WI225100000XOtherTAXONOMY