Facts
- Status
- A
- Credential
- DPT
- Type
- Individual
- Enumeration date
- 2017-01-04
- Last updated
- 2022-06-17
Specialties
Licenses
- License WI
- 13669-24
Location
- Practice location
- 167 N MAIN ST
- City
- AMHERST WI
- Postal code
- 544069028
- Phone
- 715-529-3787
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.