Individual
TANIELLE SUMMERILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2626 N WAUWATOSA AVE, WAUWATOSA, WI 53213-1137
(414) 774-7794
Mailing address
242 N 111TH ST, WAUWATOSA, WI 53226-4111
(414) 476-2304
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
990-019
WI
225200000X
Physical Therapy Assistant
PTA-300
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40459000
—
WI
Enumeration date
09/25/2006
Last updated
07/08/2007
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