Individual
LYDEL MARIE GERONDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2305 SAN LUIS PL, GREEN BAY, WI 54304-5211
(920) 494-5231
Mailing address
1112 ROLAND LN APT 16, GREEN BAY, WI 54303-6394
(920) 604-0631
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2504-19
WI
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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