Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 912019 | WI |
NPI | 1013074293 |
---|---|
Provider Name | Rebecca Lynn Windsor |
First Address | Black River Falls, WI 54615-9108 |
Second Address | Black River Falls, WI 54615-9108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40313100 | (05) | WI |
912019 | WISCONSIN LICENSE (01) | WI |