Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 14165-24 | WI |
NPI | 1013496157 |
---|---|
Provider Name | Anna Ruhland |
First Address | Mazomanie, WI 53560-9767 |
Second Address | Fitchburg, WI 53711-6498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/08/2018 |