Individual
EMILY FENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
900 E DIVISION ST, WAUTOMA, WI 54982-6944
(920) 787-6900
Mailing address
900 E DIVISION ST, WAUTOMA, WI 54982-6944
(920) 787-6900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15451-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177798
—
WI
Enumeration date
07/30/2021
Last updated
04/23/2024
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