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NPI Code Detail

MEDICARE: STEPHANIE A MIKOLICZAK PT

MEDICARE: STEPHANIE A MIKOLICZAK PT
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
1225100000XPhysical Therapist11087-24WI

General Provider Information

NPI Number : 1164672911
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE A MIKOLICZAK PT
Provider Business Mailing Address
First Line : 240 MAPLE ST
Second Line : PO BOX 470
City : WOODRUFF
State : WI
Zip : 54568-9190
Country : US
Telephone Number : 715-356-8000
Fax Number :
Provider Business Practice Location Address
First Line : 240 MAPLE ST
Second Line :
City : WOODRUFF
State : WI
Zip : 54568-9190
Country : US
Telephone Number : 715-356-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2008
Last Update Date : 09/29/2008

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Directions to “ STEPHANIE A MIKOLICZAK PT” Practice Location

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