Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1-019 | WI |
NPI | 1013095710 |
---|---|
Provider Name | Dawn M. Bednarek |
First Address | West Bend, WI 53095-9224 |
Second Address | West Bend, WI 53095-9224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 28/10/2008 |