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General NPI Number Information
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NPI Number | 1336293448
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Entity Type | Individual
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Provider Name | GINA MARIE BANDHOLZ PT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | N112W17975 MEQUON RD
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City | GERMANTOWN
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State | WI
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Zip | 53022-2425
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Country | US
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Telephone | 262-532-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 WINDY KNOLL DR
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City | HUBERTUS
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State | WI
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Zip | 53033-9302
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Country | US
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Telephone | 262-628-3608
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4942-024
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License Number State | WI
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