Individual
ANNE MARIE GONGOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11044-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100257112
—
WI
Enumeration date
07/28/2008
Last updated
06/12/2024
Update your record
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