Individual
MRS. SAMANTHA LYN FETTERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2629 N 7TH ST, SHEBOYGAN, WI 53083-4932
(920) 451-5550
(920) 451-5664
Mailing address
2120 BROADWAY AVENUE, SHEBOYGAN, WI 53081
(920) 803-8316
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
74-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40469600
—
WI
Enumeration date
05/04/2007
Last updated
10/30/2007
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