Individual
LILY ERTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7200
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16835
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100280901
—
WI
Enumeration date
06/21/2024
Last updated
10/18/2024
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