Individual
TINA NEISIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
709 MEADOW PARK DR, CLINTON, WI 53525-9777
(608) 676-2202
Mailing address
5417 E BUSS RD, CLINTON, WI 53525-8805
(608) 365-2620
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
762-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
762-19
PTA LICENSURE
WI
Enumeration date
04/16/2013
Last updated
04/16/2013
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