Healthcare Provider Details

I. General information

NPI: 1720292105
Provider Name (Legal Business Name): GINA L. OSTROWSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 NEW PINE DR
ALTOONA WI
54720-1378
US

IV. Provider business mailing address

1618 MITSCHER AVE
EAU CLAIRE WI
54701-7713
US

V. Phone/Fax

Practice location:
  • Phone: 715-833-0400
  • Fax:
Mailing address:
  • Phone: 715-839-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2401-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: