Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003329004 |
---|---|
Provider Name | Amanda Christiansen |
First Address | Superior, WI 54880-5404 |
Second Address | Superior, WI 54880-5404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 13/11/2017 |