Healthcare Provider Details

I. General information

NPI: 1053989491
Provider Name (Legal Business Name): AMBER WEGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 LAKELAND DR STE A
CHIPPEWA FALLS WI
54729-1671
US

IV. Provider business mailing address

1200 OAKLEAF WAY STE B
ALTOONA WI
54720-2217
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-5060
  • Fax: 715-723-5149
Mailing address:
  • Phone: 715-839-9266
  • Fax: 715-839-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3178-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: