Individual
SCOTT STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
677 E STATE ST, BURLINGTON, WI 53105-1639
(262) 763-9531
Mailing address
5614 E PENINSULA RD, WATERFORD, WI 53185-2964
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2533-99
WI
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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