Individual
TIFFANY ALSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
855 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3444
Mailing address
855 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3444
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1139-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11014100
—
WI
05
—
11014110
—
WI
01
—
390848401050
BLUE CROSS
WI
Enumeration date
04/14/2008
Last updated
09/13/2011
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