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General NPI Number Information
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NPI Number | 1245650837
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Entity Type | Organization
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Legal Business Name | MS. ELLE HUCK, PTA
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 7201 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-3532
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Country | US
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Telephone | 262-694-3977
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Fax | 262-694-5648
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Provider Business Mailing Address
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Address Line | 7201 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-3532
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Country | US
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Telephone | 262-694-3977
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Fax | 262-694-5648
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM H. LETSOM
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Credential | P.T.
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Telephone | 262-694-3977
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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 | 2155-19
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License Number State | WI
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