Amy M. Kline, PTA

Individual provider Active NPI Physical Therapy Assistant · Poplar, WI

NPI 1497972343 · NPPES record last updated May 2, 2008

Key facts

NPI
1497972343
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
1124-019 (WI)
Practice address
9675 E Elm Rd
Poplar, WI 54864-9102
Phone
(715) 364-8565
Fax
(715) 364-8574
NPI assigned
Apr 20, 2007
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1124-019WIMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 1124-019 WI Yes

Addresses

Primary practice location

9675 E Elm Rd
Poplar, WI 54864-9102

Mailing address

4000 N. Providence Avenue
Appleton, WI 54913-8018
Phone (920) 257-2000

Other identifiers

IdentifierTypeStateIssuer
36138200MedicaidWI

Other names

  • Amy M. Fairfield Former name

Other providers in Poplar, WI

All providers in Poplar, WI · Physical Therapy Assistant in Wisconsin

Sources for this page

Verify at the official NPI Registry.