Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 371-39 | WI |
NPI | 1205227501 |
---|---|
Provider Name | Marie Kujawa |
First Address | Hartford, WI 53027-2600 |
Second Address | Hartford, WI 53027-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2015 |
Last Update Date | 08/02/2016 |