Individual
BRIAN LEE ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
333 W MAIN ST, MADISON, WI 53703-2777
(608) 283-2123
Mailing address
7704 WESTCHESTER DR, MIDDLETON, WI 53562-3600
(608) 445-3317
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
794-019
WI
Other
Enumeration date
01/26/2007
Last updated
02/05/2014
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