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Individual

DIANE FORTEK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
19395 W CAPITOL DR STE 200, BROOKFIELD, WI 53045-2736
(414) 327-6603
Mailing address
19395 W CAPITOL DR STE 200, BROOKFIELD, WI 53045-2736
(414) 327-6603

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1919-19
WI

Other

Enumeration date
03/01/2013
Last updated
02/11/2017
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