Provider Demographics
NPI:1770793192
Name:STARSKY, KELLEEN (PT)
Entity type:Individual
Prefix:
First Name:KELLEEN
Middle Name:
Last Name:STARSKY
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 1:11339 N GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3113
Mailing Address - Country:US
Mailing Address - Phone:262-242-1263
Mailing Address - Fax:
Practice Address - Street 1:5600 W BROWN DEER RD
Practice Address - Street 2:STE. 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-355-3060
Practice Address - Fax:414-355-3547
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40469200Medicaid