Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1377624 | WI |
NPI | 1083141220 |
---|---|
Provider Name | Cassie Lynn Raduka |
First Address | Madison, WI 53704-8647 |
Second Address | Madison, WI 53718-2002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2017 |
Last Update Date | 24/03/2021 |