Individual
SAMANTHA MARIE WAHNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(126) 265-6390
Mailing address
6915 67TH ST UNIT 104, KENOSHA, WI 53142-1477
(414) 430-0308
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4350-19
WI
Other
Enumeration date
05/05/2026
Last updated
05/05/2026
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