Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2082 | WI |
NPI | 1013429356 |
---|---|
Provider Name | Scott Robertson |
First Address | Madison, WI 53705-4457 |
Second Address | Madison, WI 53705-4457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2017 |
Last Update Date | 26/10/2017 |