Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1434-024 | WI |
NPI | 1083641401 |
---|---|
Provider Name | Ms. Patricia Diane Mergener |
First Address | Madison, WI 53716-1392 |
Second Address | Madison, WI 53716-1392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 13/09/2012 |