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NPI Code Detail

MEDICARE: SUSAN ALLISON GRALAK PHYSICAL THERAPY

MEDICARE: SUSAN ALLISON GRALAK PHYSICAL THERAPY
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 Therapist13747-24WI

General Provider Information

NPI Number : 1841720703
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ALLISON GRALAK PHYSICAL THERAPY
Provider Business Mailing Address
First Line : 1266 W MAIN STREET
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590
Country : US
Telephone Number : 608-318-1357
Fax Number :
Provider Business Practice Location Address
First Line : 1266 W MAIN ST
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-1918
Country : US
Telephone Number : 608-318-1357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2017
Last Update Date : 07/21/2022

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