Individual
LISA A VIVIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
211 N BROADWAY STE 105, GREEN BAY, WI 54303-2757
(920) 432-9040
(920) 432-9053
Mailing address
4000 N PROVIDENCE AVE, APPLETON, WI 54913-8018
(920) 257-2000
(920) 257-2004
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3704-024
WI
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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