Individual
ELLEN GRANDAW MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
621 SPRING CT, RANDOM LAKE, WI 53075-1790
(920) 960-0505
Mailing address
621 SPRING CT, RANDOM LAKE, WI 53075-1790
(920) 960-0505
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4431-24
WI
Other
Enumeration date
08/23/2021
Last updated
08/23/2021
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