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NPI Code Detail

MEDICARE: ROBYN MARIE FORMANEK P.T.

MEDICARE: ROBYN MARIE FORMANEK 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 Therapist4284-024WI
2225100000XPhysical Therapist4963MN

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 : 1619946134
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBYN MARIE FORMANEK P.T.
Provider Business Mailing Address
First Line : 5585 GASLYN RD
Second Line :
City : WEBSTER
State : WI
Zip : 54893-9051
Country : US
Telephone Number : 715-866-4550
Fax Number :
Provider Business Practice Location Address
First Line : 257 W SAINT GEORGE AVE
Second Line :
City : GRANTSBURG
State : WI
Zip : 54840-7827
Country : US
Telephone Number : 715-463-5353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 07/08/2007

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