Individual
KRISTA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
417 3RD AVE, CLEAR LAKE, WI 54005
(715) 263-4103
(866) 245-8064
Mailing address
PO BOX 3497, STURTEVANT, WI 53177-0300
(888) 201-1040
(866) 245-8064
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1712-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265721781
—
WI
Enumeration date
04/05/2011
Last updated
05/11/2011
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