Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 4778-024 | WI |
NPI | 1083655617 |
---|---|
Provider Name | Mrs. Ann Marie Hessil |
First Address | Wauwatosa, WI 53226-1443 |
Second Address | Muskego, WI 53150-2713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 25/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000201499 | MEDICARE (01) | WI |