Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 11565-24 | WI |
NPI | 1528316668 |
---|---|
Provider Name | Stacie Sauer Tierney |
First Address | Verona, WI 53593-7937 |
Second Address | Madison, WI 53715-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/08/2012 |