Individual
MR. EDWARD M. LEITZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2705 ENLOE ST, HUDSON, WI 54016-8173
(715) 386-2128
(715) 386-6119
Mailing address
211 WARWICK ST SE, MINNEAPOLIS, MN 55414-3622
(612) 379-8172
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
451
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40176300
—
WI
Enumeration date
09/20/2006
Last updated
07/09/2007
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