Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 753019 | WI |
NPI | 1003084880 |
---|---|
Provider Name | Alicia Myher |
First Address | Holmen, WI 54636-9467 |
Second Address | Holmen, WI 54636-9467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 22/01/2016 |