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General NPI Number Information
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NPI Number | 1417459926
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Entity Type | Individual
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Provider Name | MARY EHRHARDT
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 14345 COUNTY HIGHWAY B
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City | SPARTA
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State | WI
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Zip | 54656-4509
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Country | US
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Telephone | 608-269-8825
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Fax |
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Provider Business Mailing Address
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Address Line | 106 S HOLMEN DR
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City | HOLMEN
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State | WI
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Zip | 54636-9467
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Country | US
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Telephone | 608-526-9888
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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 | 2616-19
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License Number State | WI
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