Kathy Jo Anderson, PTA

Individual provider Active NPI Physical Therapy Assistant · Merrill, WI

NPI 1679832349 · NPPES record last updated May 15, 2012

Key facts

NPI
1679832349
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
542-19 (WI)
Practice address
601 S Center Ave
Merrill, WI 54452-3404
Phone
(715) 539-2466
Fax
(715) 539-2462
NPI assigned
May 15, 2012
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
542-19WIMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 542-19 WI Yes

Addresses

Primary practice location

601 S Center Ave
Merrill, WI 54452-3404

Mailing address

601 S Center Ave
Merrill, WI 54452-3404
Phone (715) 539-2466

Other providers in Merrill, WI

All providers in Merrill, WI · Physical Therapy Assistant in Wisconsin

Sources for this page

Verify at the official NPI Registry.