Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1338-019 | WI |
NPI | 1003073537 |
---|---|
Provider Name | Mrs. Sara Thayer |
First Address | Dodgeville, WI 53533-1956 |
Second Address | Dodgeville, WI 53533-1956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/05/2008 |