Individual
GOWA TUNDUP LAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1635 S 21ST ST, MANITOWOC, WI 54220-6380
(920) 684-7171
Mailing address
1223 N 6TH ST, SHEBOYGAN, WI 53081-3515
(209) 631-5956
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3101
WI
Other
Enumeration date
06/24/2022
Last updated
06/24/2022
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