Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 4186-024 | WI |
NPI | 1700944550 |
---|---|
Provider Name | Charlene Renee Puskala |
First Address | Madison, WI 53715-1507 |
Second Address | Madison, WI 53715-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36124000 | (05) | WI |