Individual
MISS RANDI ROSE FENNIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6263 N GREEN BAY AVE, GLENDALE, WI 53209-3823
(414) 351-0543
Mailing address
10355 W PLUM TREE CIR APT 201, HALES CORNERS, WI 53130-2634
(414) 614-1244
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
314319
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314319
PHYSICAL THERAPIST ASSISTANT
WI
Enumeration date
08/17/2021
Last updated
08/17/2021
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