Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1224-19 | WI |
NPI | 1023120425 |
---|---|
Provider Name | Mr. Todd Weibel |
First Address | La Crosse, WI 54601-7729 |
Second Address | Tomah, WI 54660-3105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |