Individual
AMY JO HAVERKORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2763 MANITOWOC RD, SUITE B, GREEN BAY, WI 54311-6633
(920) 468-8288
(920) 468-9887
Mailing address
2763 MANITOWOC RD, SUITE B, GREEN BAY, WI 54311-6633
(920) 468-8288
(920) 468-9887
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
223-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223-19
LICENSE NUMBER
WI
Enumeration date
10/04/2011
Last updated
10/04/2011
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