Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1498-019 | WI |
NPI | 1013156876 |
---|---|
Provider Name | Amanda Lynn Scharninghausen |
First Address | Racine, WI 53406-5344 |
Second Address | Kenosha, WI 53140-1924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2009 |
Last Update Date | 18/02/2009 |