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General NPI Number Information
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NPI Number | 1578136131
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Entity Type | Individual
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Provider Name | HALIE JO PAW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 3485 WINDSOR AVE
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City | DUBUQUE
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State | IA
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Zip | 52001-1329
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Country | US
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Telephone | 563-557-7180
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Fax |
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Provider Business Mailing Address
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Address Line | 609 CHESTNUT ST
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City | DUBUQUE
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State | IA
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Zip | 52001-6219
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Country | US
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Telephone | 708-921-3420
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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 | 108349
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License Number State | IA
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