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General NPI Number Information
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NPI Number | 1255507604
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Entity Type | Individual
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Provider Name | ROBERT PAUL NEUSTIFTER PTA
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Gender | Male
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 215 N WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-4813
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Country | US
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Telephone | 920-431-5588
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Fax | 920-445-7090
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Provider Business Mailing Address
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Address Line | PO BOX 638
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City | GREEN BAY
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State | WI
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Zip | 54305-0638
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Country | US
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Telephone | 920-246-3126
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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 | 1162-019
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License Number State | WI
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