Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 9742024 | WI |
NPI | 1235325598 |
---|---|
Provider Name | Nicole Barton |
First Address | Waupaca, WI 54981-8454 |
Second Address | Waupaca, WI 54981-2027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2007 |
Last Update Date | 20/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40390700 | (05) | WI |