Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1539-019 | WI |
NPI | 1013216829 |
---|---|
Provider Name | Mrs. Tammy Marie Czarnecki |
First Address | Kenosha, WI 53142-7884 |
Second Address | Kenosha, WI 53142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2011 |
Last Update Date | 18/03/2011 |