Individual
PAMELA H FORNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
600 HIGHLAND AVE, COMPLIANCE MAIL CODE 2433, MADISON, WI 53792-0001
(608) 263-8412
Mailing address
600 HIGHLAND AVE, COMPLIANCE MAIL CODE 2433, MADISON, WI 53792-0001
(608) 263-8412
(608) 263-5011
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1353-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1353-24
PT - ORTHO
WI
Enumeration date
08/05/2006
Last updated
07/08/2007
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