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General NPI Number Information
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NPI Number | 1629327200
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Entity Type | Individual
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Provider Name | ANNA WISSINK PTA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 200 S. NINTH ST. RENNES HEALTH AND REHAB CENTER,
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City | DE PERE
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State | WI
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Zip | 54115
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Country | US
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Telephone | 920-338-4145
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Fax | 920-338-9121
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Provider Business Mailing Address
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Address Line | 411 ST. MARY'S BLVD
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City | GREEN BAY
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State | WI
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Zip | 54301
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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 | 1930-19
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License Number State | WI
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