Individual
AMY BETH FLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
955 MAIN ST STE CD, MUKWONAGO, WI 53149-1752
(262) 662-9760
(262) 662-9761
Mailing address
29632 CLOVER LN, WATERFORD, WI 53185-5004
(414) 640-0335
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
348-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40437000
—
WI
Enumeration date
07/03/2006
Last updated
11/27/2024
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