Individual
MICHELLE HALVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 GRANDVIEW AVE, BLAIR, WI 54616-1101
(608) 989-2195
Mailing address
36188 CHRISTINE BLVD, WHITEHALL, WI 54773-8618
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1850-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100028877
—
WI
Enumeration date
11/27/2012
Last updated
02/04/2019
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