Individual
MRS. TAMMY LUELLA GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
W6990 S SILVER LAKE RD, WAUTOMA, WI 54982-5890
(920) 787-4766
Mailing address
932 W 5TH ST, NEKOOSA, WI 54457-1075
(715) 886-2973
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1129-019
WI
Other
Enumeration date
03/16/2011
Last updated
03/16/2011
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