Individual
MR. MARK ALLEN MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA10
Contact information
Practice address
3471 S KANSAS AVE, MILWAUKEE, WI 53207-3654
(414) 486-1307
Mailing address
3471 S KANSAS AVE, MILWAUKEE, WI 53207-3654
(414) 486-1307
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0848-19
WI
Other
Enumeration date
06/16/2006
Last updated
11/06/2013
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