Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2173-19 | WI |
NPI | 1013398288 |
---|---|
Provider Name | Denise Rae Perry |
First Address | Stoughton, WI 53589-1857 |
Second Address | Stoughton, WI 53589-1857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2015 |
Last Update Date | 14/06/2015 |