Individual
LAURIE J. THIEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT-A
Contact information
Practice address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 743-5566
Mailing address
1300 EGG HARBOR RD, STURGEON BAY, WI 54235-1277
(920) 746-0410
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1316-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40249300
—
WI
Enumeration date
09/27/2006
Last updated
07/08/2007
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