Individual
EAN VAN VLIET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
323 WEST MONROE STREET, WYOCENA, WI 53969
(608) 429-2181
Mailing address
5162 ANTON DR APT 301, FITCHBURG, WI 53719-1716
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1945
WI
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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