Kris M Mickelson

NPI #1356856199 in Pewaukee, Wisconsin

Provider Information

NPI Number: 1356856199
Entity Type: Individual
Name: Kris M Mickelson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Dec 1, 2017
Last Updated: Dec 1, 2017

Practice Location

Address: N30W23913 GREEN RD APT 7
City: Pewaukee
State: Wisconsin
ZIP Code: 53072-5766
Phone: (414) 426-3859

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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