Individual
MRS. DAWNINE MARIE BOLDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
200 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9678
(920) 648-8170
(920) 648-8225
Mailing address
200 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9678
(920) 648-8170
(920) 648-8225
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
966-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36149300
—
WI
Enumeration date
02/14/2008
Last updated
02/14/2008
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