Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 12587-24 | WI |
NPI | 1003183138 |
---|---|
Provider Name | Asha Pumphrey |
First Address | Milwaukee, WI 53221-5420 |
Second Address | Milwaukee, WI 53221-5420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2011 |
Last Update Date | 18/01/2015 |