Individual
MRS. LAURA JEAN WAALKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, PTA
Contact information
Practice address
5000 MEMORIAL DRIVE, TWO RIVERS, WI 54241-7316
(920) 794-5381
Mailing address
1215 S 12TH ST, MANITOWOC, WI 54220-5223
(920) 645-3062
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2719-019
WI
2255A2300X
Athletic Trainer
999-039
WI
Other
Enumeration date
06/09/2009
Last updated
07/31/2014
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