Healthcare Provider Details

I. General information

NPI: 1013541010
Provider Name (Legal Business Name): MARILYNN TOEPEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S11W29667 SUMMIT AVE
WAUKESHA WI
53188-9476
US

IV. Provider business mailing address

W133N6242 HUMMINGBIRD WAY
MENOMONEE FALLS WI
53051-8330
US

V. Phone/Fax

Practice location:
  • Phone: 262-565-6124
  • Fax:
Mailing address:
  • Phone: 414-322-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6007-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: