Individual
MAUREEN J FANTAZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5663 S 27TH ST, MILWAUKEE, WI 53221-4107
(414) 282-7810
(414) 282-9120
Mailing address
PO BOX 0811433, RACINE, WI 53408-4133
(262) 321-0240
(262) 321-0242
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1533-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40019500
—
WI
Enumeration date
07/24/2006
Last updated
07/08/2007
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