Individual
CHRISTIE IVA GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
706 BRATLEY DRIVE, WASHBURN, WI 54891
(715) 373-6425
(715) 373-5655
Mailing address
706 BRATLEY DR, WASHBURN, WI 54891-1143
(715) 373-6425
(715) 373-5655
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
565-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20194600
—
WI
Enumeration date
11/13/2009
Last updated
09/10/2015
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