Individual
TRACY BANTLEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3129 MICHIGAN AVE, SHEBOYGAN, WI 53081-3062
(920) 458-1155
(920) 458-1173
Mailing address
3129 MICHIGAN AVE, SHEBOYGAN, WI 53081-3062
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1999-19
WI
Other
Enumeration date
06/20/2014
Last updated
06/20/2014
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