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General NPI Number Information
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NPI Number | 1104158922
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Entity Type | Individual
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Provider Name | SARAH ANN GROTKIEWICZ PTA
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Gender | Female
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 531 GIDDINGS AVE
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City | SHEBOYGAN FALLS
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State | WI
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Zip | 53085-1707
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Country | US
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Telephone | 920-550-5254
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Fax |
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Provider Business Mailing Address
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Address Line | W55N453 LENOX PL APT 4
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City | CEDARBURG
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State | WI
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Zip | 53012-2548
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Country | US
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Telephone | 262-377-5870
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Fax |
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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 | 298-19
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License Number State | WI
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