Individual
MS. MARGARET (PEG) A WANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12189-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010793355
PRESBYTERIAN HEALTHCARE
NM
01
—
850395469
MUTUAL OF OMAHA
NM
01
—
NM00Q500
BCBS PROVIDER #
NM
Enumeration date
04/03/2006
Last updated
01/07/2014
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