Healthcare Provider Details

I. General information

NPI: 1184822876
Provider Name (Legal Business Name): COURTNEY SUE SPAETH P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY SUE STOWELL P.T.A.

II. Dates (important events)

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

III. Provider practice location address

215 E BROWN ST
AUGUSTA WI
54722-9346
US

IV. Provider business mailing address

31221 30TH AVE.
BOYD WI
54726-0001
US

V. Phone/Fax

Practice location:
  • Phone: 715-559-6348
  • Fax:
Mailing address:
  • Phone: 715-667-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1125-019
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: