Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1456-019 | WI |
NPI | 1104143809 |
---|---|
Provider Name | Mrs. Marie A Sager |
First Address | Racine, WI 53406 |
Second Address | Racine, WI 53406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 21/04/2010 |