MEDICARE: JOANN MENSE 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
1	225200000X	Physical Therapy Assistant	1803-19	WI

General Provider Information

NPI Number	:	1982973558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN MENSE PTA

Provider Business Mailing Address
First Line	:	N5604 COUNTY ROAD PP
Second Line	:
City	:	DURAND
State	:	WI
Zip	:	54736-4503
Country	:	US
Telephone Number	:	715-672-4715
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E DALLAS ST
Second Line	:
City	:	DALLAS
State	:	WI
Zip	:	54733-9699
Country	:	US
Telephone Number	:	715-837-1222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	12/27/2011

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Directions to “ JOANN MENSE PTA” Practice Location

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