Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1717-19 | WI |
NPI | 1003116583 |
---|---|
Provider Name | Elizabeth Marie Petrowitz |
First Address | Grantsburg, WI 54840-7827 |
Second Address | Grantsburg, WI 54840-7827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2010 |
Last Update Date | 29/10/2010 |