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NPI Code Detail

MEDICARE: MRS. LAURIE ANN RADKE PTA

MEDICARE: MRS. LAURIE ANN RADKE 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
1225200000XPhysical Therapy Assistant76-019WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326269085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURIE ANN RADKE PTA
Provider Business Mailing Address
First Line : 230 PHILLIPS DR
Second Line :
City : MARSHALL
State : WI
Zip : 53559-9154
Country : US
Telephone Number : 608-655-1671
Fax Number :
Provider Business Practice Location Address
First Line : 901 MULBERRY ST
Second Line :
City : LAKE MILLS
State : WI
Zip : 53551-1335
Country : US
Telephone Number : 920-648-3144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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