Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 9816-24 | WI |
NPI | 1003833823 |
---|---|
Provider Name | Heidi L Mancusi |
First Address | Madison, WI 53792-0001 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |