Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 557-019 | WI |
NPI | 1013120872 |
---|---|
Provider Name | Mrs. Christine Marie Churchill |
First Address | Milwaukee, WI 53221-3950 |
Second Address | Milwaukee, WI 53221-4814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36126900 | (05) | WI |