Basic Information
| Provider Information | |||||||||
| NPI: | 1760021190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLOTZ | ||||||||
| FirstName: | COLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2921 S MABBETT AVE | ||||||||
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| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532072524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147910550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6255 N SANTA MONICA BLVD | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532174353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149678350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2020 | ||||||||
| LastUpdateDate: | 01/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.