Individual
MRS. NAKIA DAISY KONWENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6101 16TH ST, RACINE, WI 53406-4467
(262) 898-2777
Mailing address
6101 16TH ST, RACINE, WI 53406-4467
(262) 898-2777
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1869-19
WI
Other
Enumeration date
09/27/2013
Last updated
10/10/2013
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