Individual
HEATHER LYNN BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1436 S LINCOLN ST, SHAWANO, WI 54166-3427
(715) 526-6111
Mailing address
PO BOX 247, SHAWANO, WI 54166-0247
(715) 304-8470
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2836-19
WI
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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