Individual
AUDREY MARY WALDSCHMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1229 S JACKSON ST, GREEN BAY, WI 54301-3037
(920) 437-6523
Mailing address
3223 WALL ST, GREEN BAY, WI 54311-9601
(920) 863-8416
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
242-19
WI
Other
Enumeration date
07/01/2012
Last updated
07/01/2012
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