Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1963-24 | WI |
N | 2251P0200X | Physical Therapist - Pediatrics | 4572 | MN |
NPI | 1114190618 |
---|---|
Provider Name | Nancy Ellen Reithel |
First Address | Onalaska, WI 54650 |
Second Address | Onalaska, WI 54650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 07/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40149200 | (05) | WI |