Individual
MARY P GANTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2801 S WEBSTER AVE, GREEN BAY, WI 54301-2878
(920) 337-1122
Mailing address
2251 MEADOW RIDGE DR, DE PERE, WI 54115-7996
(920) 338-0721
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3432
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40138100
—
WI
Enumeration date
06/20/2007
Last updated
07/08/2007
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