Provider Demographics
NPI:1740489715
Name:BENKE, KATHRYN JANE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JANE
Last Name:BENKE
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 1:465 GLENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4152
Mailing Address - Country:US
Mailing Address - Phone:507-494-7365
Mailing Address - Fax:
Practice Address - Street 1:270 NORTH ST.
Practice Address - Street 2:
Practice Address - City:FOUNTAIN CITY
Practice Address - State:WI
Practice Address - Zip Code:54629
Practice Address - Country:US
Practice Address - Phone:608-687-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4858-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist