Individual
CLINTON MELLIZA MAGNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 PIONEER DR, BELOIT, WI 53511-3025
(608) 365-9526
Mailing address
926 PARK PL, MILTON, WI 53563-1336
(608) 577-9044
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
042424-01
NY
225100000X
Physical Therapist
Primary
14502-24
WI
225100000X
Physical Therapist
24302
MA
Other
Enumeration date
01/17/2023
Last updated
01/17/2023
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