Individual
MR. ANTHONY JACK ETTMAYER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1119 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1209
(262) 284-5892
Mailing address
1119 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1209
(262) 284-5892
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11821-024
WI
Other
Enumeration date
07/13/2011
Last updated
07/13/2011
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