Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 320-19 | WI |
NPI | 1013181122 |
---|---|
Provider Name | Michele Stroncek |
First Address | Greenfield, WI 53220-4819 |
Second Address | Greenfield, WI 53220-4819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 18/04/2008 |