Individual
MRS. LAURIE ANN RADKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
901 MULBERRY ST, LAKE MILLS, WI 53551-1335
(920) 648-3144
Mailing address
230 PHILLIPS DR, MARSHALL, WI 53559-9154
(608) 655-1671
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
76-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40246300
—
WI
Enumeration date
05/01/2007
Last updated
07/08/2007
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