MEDICARE: MELISSA STANUL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	494-019	WI

General Provider Information

NPI Number	:	1073770723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA STANUL PTA

Provider Business Mailing Address
First Line	:	25951 CIRCLE VIEW DR
Second Line	:
City	:	RICHLAND CENTER
State	:	WI
Zip	:	53581-4013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25951 CIRCLE VIEW DR
Second Line	:
City	:	RICHLAND CENTER
State	:	WI
Zip	:	53581-4013
Country	:	US
Telephone Number	:	608-647-2138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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