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General NPI Number Information
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NPI Number | 1841670015
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Entity Type | Individual
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Provider Name | JILL VANSTRYDONK PTA
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Gender | Female
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 202 W MOHAWK DR MINISTRY HEAD 2 TOE THERAPY
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City | TOMAHAWK
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State | WI
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Zip | 54487
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Country | US
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Telephone | 715-453-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 2251 N SHORE DR STE 100
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City | RHINELANDER
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State | WI
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Zip | 54501-6710
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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 | 2021-19
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License Number State | WI
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