Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 96 | WI |
NPI | 1003856196 |
---|---|
Provider Name | Mr. Steven C. Majstoravich |
First Address | Milwaukee, WI 53226-4837 |
Second Address | Milwaukee, WI 53226-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36107800 | (05) | WI |