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NPI Code Detail

MEDICARE: JAMIE WOHLT PTA

MEDICARE: JAMIE WOHLT 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 Assistant518-19WI

General Provider Information

NPI Number : 1558638007
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE WOHLT PTA
Provider Business Mailing Address
First Line : E7644 COUNTY ROAD H
Second Line :
City : FREMONT
State : WI
Zip : 54940-9745
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1226 BERLIN ST
Second Line :
City : WAUPACA
State : WI
Zip : 54981-1991
Country : US
Telephone Number : 715-258-5521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2011
Last Update Date : 11/29/2011

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Directions to “ JAMIE WOHLT PTA” Practice Location

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