Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1508-19 | WI |
NPI | 1003176439 |
---|---|
Provider Name | Dawn Newsome |
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 | 18/05/2012 |
Last Update Date | 18/05/2012 |