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NPI Code Detail

MEDICARE: AMANDA GASKA DPT

MEDICARE: AMANDA GASKA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist12779WI

General Provider Information

NPI Number : 1245692821
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GASKA DPT
Provider Business Mailing Address
First Line : 19525 W NORTH AVE
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-4107
Country : US
Telephone Number : 262-780-3813
Fax Number :
Provider Business Practice Location Address
First Line : 19525 W NORTH AVE
Second Line :
City : BROOKFIELD
State : WI
Zip : 53045-4107
Country : US
Telephone Number : 262-780-3813
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2016
Last Update Date : 03/23/2016

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