Individual
NICOLE REZACHEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
(262) 376-5208
Mailing address
N27W5707 LINCOLN BLVD, CEDARBURG, WI 53012-2852
(262) 376-7676
(262) 376-5208
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2197-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING APPLICATION
—
WI
Enumeration date
07/28/2014
Last updated
07/28/2014
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