Individual
AMANDA KAY BASSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7500 W NORTH AVE, MILWAUKEE, WI 53213-1717
(414) 258-6170
Mailing address
N2263 WILMOT BLVD, LAKE GENEVA, WI 53147-2332
(262) 417-6845
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2811-19
WI
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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