Individual
TARA KORSLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
114 E GREEN TREE RD, CLINTONVILLE, WI 54929-1182
(715) 823-3336
Mailing address
1000 MIDWAY RD, MENASHA, WI 54952-1116
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3309-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3309-19
WI LICENSE
WI
Enumeration date
10/19/2022
Last updated
10/19/2022
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