Provider Demographics
NPI:1881927713
Name:KOEHLER, ROSS TIMOTHY (ATC)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:TIMOTHY
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S. 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-566-3803
Mailing Address - Fax:414-566-3866
Practice Address - Street 1:1900 W SUMNER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027
Practice Address - Country:US
Practice Address - Phone:262-673-1261
Practice Address - Fax:262-673-1644
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1024-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer