Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 12206-24 | WI |
NPI | 1093214371 |
---|---|
Provider Name | Melissa M Mikuski |
First Address | Madison, WI 53718-4409 |
Second Address | Madison, WI 53718-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 01/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12206-24 | PHYSICAL THERAPIST (01) | WI |