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General NPI Number Information
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NPI Number | 1093915472
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Entity Type | Individual
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Provider Name | DIANE ELIZABETH ANDERSON PTA
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 316 N MILWAUKEE ST STE 208
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City | MILWAUKEE
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State | WI
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Zip | 53202-5803
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Country | US
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Telephone | 414-615-0665
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Fax | 414-615-0667
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Provider Business Mailing Address
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Address Line | 17085 W NATIONAL AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-5523
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Country | US
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Telephone | 262-617-7748
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Fax | 262-786-1087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1329-019
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License Number State | WI
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