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General NPI Number Information
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NPI Number | 1609967546
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Entity Type | Individual
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Provider Name | ANN ELIZABETH MCKENNA PTA
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2900 CURRY LN NEW CURATIVE REHABILITATION
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City | GREEN BAY
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State | WI
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Zip | 54311-5857
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Country | US
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Telephone | 920-468-9129
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 HARVEY ST
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City | GREEN BAY
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State | WI
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Zip | 54302-1410
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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 | 846-019
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License Number State | WI
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