Individual
MS. ANGELA LEE WILLIQUETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
265 S NATIONAL AVE, FOND DU LAC, WI 54935-5334
(920) 922-7342
Mailing address
5 14TH ST APT 7, FOND DU LAC, WI 54935-5857
(920) 475-7852
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
172-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
-
—
WI
Enumeration date
06/29/2021
Last updated
06/29/2021
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