Individual
MIA A LODAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2600 RIB MOUNTAIN DR STE 220, WAUSAU, WI 54401-7196
(715) 843-5300
(715) 843-5329
Mailing address
2600 RIB MOUNTAIN DR STE 220, WAUSAU, WI 54401-7196
(715) 843-5300
(715) 843-5329
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11719024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
526595
MEDICARE ORF PROVIDER NUMBER
WI
Enumeration date
06/17/2011
Last updated
08/08/2011
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