Individual
MRS. KELLY LYNN BERNA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
116 N MAIN ST, SHAWANO, WI 54166-2356
(715) 526-7370
(715) 526-7294
Mailing address
116 N MAIN ST, SHAWANO, WI 54166-2356
(715) 526-7370
(715) 526-7294
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
24019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40390300
—
WI
Enumeration date
09/26/2005
Last updated
07/08/2007
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