Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | WI |
NPI | 1053573584 |
---|---|
Provider Name | Maria Elizabeth Statz |
First Address | Wisconsin Rapids, WI 54494-1906 |
Second Address | Wisconsin Rapids, WI 54494-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 08/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36187000 | (05) | WI |