Healthcare Provider Details

I. General information

NPI: 1629346762
Provider Name (Legal Business Name): MARCIA DEE HUFFEY MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2011
Last Update Date: 12/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 STATE ROAD 16
LA CROSSE WI
54601-3011
US

IV. Provider business mailing address

1802 STATE ROAD 16
LA CROSSE WI
54601-3011
US

V. Phone/Fax

Practice location:
  • Phone: 608-779-0900
  • Fax: 608-779-0903
Mailing address:
  • Phone: 608-779-0900
  • Fax: 608-779-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9861-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: