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NPI Code Detail

MEDICARE: CERASELA LAURA CAIA PTA

MEDICARE: CERASELA LAURA CAIA 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 Assistant1748-019WI

General Provider Information

NPI Number : 1831449776
Entity Type Code : Individual
Provider Name (Legal Business Name) : CERASELA LAURA CAIA PTA
Provider Business Mailing Address
First Line : 1414 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-3018
Country : US
Telephone Number : 414-277-8846
Fax Number : 414-276-2332
Provider Business Practice Location Address
First Line : 1414 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-3018
Country : US
Telephone Number : 414-277-8846
Fax Number : 414-276-2332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2012
Last Update Date : 09/18/2012

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Directions to “ CERASELA LAURA CAIA PTA” Practice Location

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