Individual
MRS. EVA MARIE GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7830 STATE HIGHWAY 13, PORT WING, WI 54865-4721
(715) 774-3195
Mailing address
7830 STATE HIGHWAY 13, PORT WING, WI 54865-4721
(715) 774-3195
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4231-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40163400
—
WI
Enumeration date
04/10/2008
Last updated
04/10/2008
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