Individual
CHARMAINE A UNTIEDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6004
(608) 260-6906
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6004
(608) 260-6906
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
3330-024
WI
225100000X
Physical Therapist
Primary
3330-024
WI
Other
Enumeration date
10/17/2006
Last updated
01/07/2021
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