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NPI Code Detail

MEDICARE: SCOTT A GLOWACKI PTA

MEDICARE: SCOTT A GLOWACKI PTA
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
1225200000XPhysical Therapy Assistant476019WI

General Provider Information

NPI Number : 1376879734
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT A GLOWACKI PTA
Provider Business Mailing Address
First Line : 875 W LAYTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-2426
Country : US
Telephone Number : 414-489-3810
Fax Number : 414-489-3811
Provider Business Practice Location Address
First Line : 875 W LAYTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-2426
Country : US
Telephone Number : 414-489-3810
Fax Number : 414-489-3811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2009
Last Update Date : 10/20/2009

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Directions to “ SCOTT A GLOWACKI PTA” Practice Location

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