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NPI Code Detail

MEDICARE: ROXANN KAY NEDRELO P.T.

MEDICARE: ROXANN KAY NEDRELO P.T.
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 Therapist2455-024WI
2225100000XPhysical Therapist4377MN

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 : 1568638401
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXANN KAY NEDRELO P.T.
Provider Business Mailing Address
First Line : 1311 TYLER ST
Second Line :
City : BLACK RIVER FALLS
State : WI
Zip : 54615-1564
Country : US
Telephone Number : 715-284-4396
Fax Number : 715-284-9580
Provider Business Practice Location Address
First Line : 1311 TYLER ST
Second Line :
City : BLACK RIVER FALLS
State : WI
Zip : 54615-1564
Country : US
Telephone Number : 715-284-4396
Fax Number : 715-284-9580
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2008
Last Update Date : 04/30/2008

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Directions to “ ROXANN KAY NEDRELO P.T.” Practice Location

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