Individual
SANDRA TOLLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1800 NEW YORK AVE, SUPERIOR, WI 54880-2008
(715) 394-5591
Mailing address
1800 NEW YORK AVE, SUPERIOR, WI 54880-2008
(715) 394-5591
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1389-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1389-019
STATE LICENSE NUMBER
WI
Enumeration date
04/30/2009
Last updated
04/30/2009
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