Provider Demographics
NPI:1720294028
Name:MAGGIORI, KIM (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MAGGIORI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N54W17640 WALNUT WAY
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7853
Mailing Address - Country:US
Mailing Address - Phone:262-415-5136
Mailing Address - Fax:
Practice Address - Street 1:912 N HAWLEY RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-3222
Practice Address - Country:US
Practice Address - Phone:414-615-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40208800Medicaid