Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5827-24 | WI |
N | 2251N0400X | Physical Therapist - Neurology | 7475 | TN |
NPI | 1285013953 |
---|---|
Provider Name | Lisa J Truttschel |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54301-3505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2015 |
Last Update Date | 16/11/2015 |