Healthcare Provider Details

I. General information

NPI: 1619941515
Provider Name (Legal Business Name): MARY BETH NAWROCKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BETH BRAUN PT

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DELAFIELD ST SUITE 120
WAUKESHA WI
53188-3417
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 262-521-9762
  • Fax:
Mailing address:
  • Phone: 630-296-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9634-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: