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Individual

SHANTRICE LAFAVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
8274 E SAN RD, SOUTH RANGE, WI 54874-8621
(715) 398-3523
Mailing address
8274 E SAN RD, SOUTH RANGE, WI 54874-8621
(715) 398-3523

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1841-19
WI
225200000X
Physical Therapy Assistant
A1444
MN

Other

Enumeration date
11/23/2012
Last updated
11/23/2012
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