Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 668027 | WI |
NPI | 1013133040 |
---|---|
Provider Name | Mrs. Debra Lynn Ahlborn |
First Address | Greenfield, WI 53221-2516 |
Second Address | Greenfield, WI 53228-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |