Individual
MRS. BETSY M SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
725 BUTLER AVENUE, WINNEBAGO, WI 54985-0010
(920) 235-5100
(920) 233-7352
Mailing address
1541 OAK ST, OSHKOSH, WI 54901
(920) 231-5492
(920) 233-7352
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
714019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40159400
—
WI
Enumeration date
01/25/2007
Last updated
07/08/2007
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