Individual
TINA MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
331 S WATER ST, SPARTA, WI 54656-1726
(608) 366-6239
Mailing address
331 S WATER ST, SPARTA, WI 54656-1726
(608) 366-6239
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2314
WI
Other
Enumeration date
01/26/2016
Last updated
01/26/2016
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