Individual
MARIA FAIRBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T. AIDE
Contact information
Practice address
900 COLLEGE AVE. WEST, LADYSMITH, WI 54848
(715) 532-5561
(715) 532-9809
Mailing address
W5810 HAPPY ACRES ROAD, TONY, WI 54563
(715) 532-6669
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1008
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40436100
—
WI
Enumeration date
10/03/2006
Last updated
07/09/2007
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