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General NPI Number Information
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NPI Number | 1114306875
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Entity Type | Individual
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Provider Name | MICHAEL E ONSRUD PTA
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Gender | Male
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 1020 HILL ST
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City | WATERTOWN
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State | WI
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Zip | 53098-3016
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Country | US
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Telephone | 920-261-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 MOUND ST APT 307
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City | MADISON
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State | WI
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Zip | 53715-1531
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Country | US
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Telephone | 608-852-3541
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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 | 2257-19
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License Number State | WI
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