Individual
TINA MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 PILGRIM WAY, GREEN BAY, WI 54304-5028
(920) 405-3522
Mailing address
420 WHISPERING CREEK CT, GREEN BAY, WI 54303-6029
(920) 496-0304
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
449-19
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40317600
—
WI
Enumeration date
08/16/2006
Last updated
03/06/2012
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