Individual
NICOLE WATHKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
614 S ROCK AVE, VIROQUA, WI 54665
(608) 637-2171
Mailing address
20643 JUNEAU RD, WILTON, WI 54670-6127
(608) 372-4695
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
729
WI
Other
Enumeration date
05/15/2008
Last updated
01/26/2012
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