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General NPI Number Information
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NPI Number | 1376805879
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Entity Type | Individual
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Provider Name | COURTNEY A STUEBS PTA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 500 GRANT AVE
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City | OMRO
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State | WI
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Zip | 54963-1342
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Country | US
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Telephone | 920-859-0269
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 E PARIS WAY APT 4
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City | APPLETON
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State | WI
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Zip | 54913-8307
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Country | US
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Telephone |
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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 | 1357-19
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License Number State | WI
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