Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 965-19 | WI |
NPI | 1023068848 |
---|---|
Provider Name | Miss Dianne Lynn Wadzinski |
First Address | Marshfield, WI 54449 |
Second Address | Arpin, WI 54410-9558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 14/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100006660 | (05) | WI |