Individual
HEATHER FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
159 S MAIN ST, DICKEYVILLE, WI 53808-6836
(608) 723-9772
Mailing address
PO BOX 342, DICKEYVILLE, WI 53808-0342
(608) 723-9772
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
083753
IA
225200000X
Physical Therapy Assistant
2474
WI
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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