Individual
MRS. MARY ELLEN HUMPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4010 S 104TH ST, GREENFIELD, WI 53228-2012
(414) 545-4423
Mailing address
4010 S 104TH ST, GREENFIELD, WI 53228-2012
(414) 545-4423
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1909-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40090400
—
WI
Enumeration date
05/10/2008
Last updated
05/10/2008
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