Individual
MS. MYRTLE FAYE EATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4355 N 68TH ST, MILWAUKEE, WI 53216-1118
(414) 536-6160
Mailing address
4355 N 68TH ST, MILWAUKEE, WI 53216-1118
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
665-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40466800
—
WI
Enumeration date
04/15/2008
Last updated
04/15/2008
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