Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 13015-24 | WI |
NPI | 1003296526 |
---|---|
Provider Name | Mrs. Danialle Draeger |
First Address | Onalaska, WI 54650-8679 |
Second Address | Onalaska, WI 54650-8679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 01/06/2015 |