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General NPI Number Information
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NPI Number | 1982973558
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Entity Type | Individual
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Provider Name | JOANN MENSE PTA
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Gender | Female
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 104 E DALLAS ST
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City | DALLAS
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State | WI
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Zip | 54733-9699
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Country | US
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Telephone | 715-837-1222
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Fax |
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Provider Business Mailing Address
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Address Line | N5604 COUNTY ROAD PP
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City | DURAND
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State | WI
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Zip | 54736-4503
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Country | US
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Telephone | 715-672-4715
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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 | 1803-19
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License Number State | WI
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