Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 505-019 | WI |
NPI | 1003070269 |
---|---|
Provider Name | Cristy Berkholtz |
First Address | Neenah, WI 54956-4015 |
Second Address | Neenah, WI 54956-4015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10278000 | (05) | WI |