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General NPI Number Information
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NPI Number | 1205284528
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Entity Type | Individual
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Provider Name | BOYANA B MERCER PTA
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 710 WILLOW ST
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City | PESHTIGO
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State | WI
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Zip | 54157-9200
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Country | US
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Telephone | 715-582-1044
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Fax | 715-582-0803
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Provider Business Mailing Address
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Address Line | 701 WILLOW ST
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City | PESHTIGO
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State | WI
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Zip | 54157-9200
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Country | US
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Telephone | 715-582-0144
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Fax | 715-582-0803
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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 | 2079
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License Number State | WI
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