Individual
MS. EVA JEAN DETTLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3100 W EDGERTON AVE, GREENFIELD, WI 53221-3116
(262) 302-9412
Mailing address
3100 W EDGERTON AVE, GREENFIELD, WI 53221-3116
(262) 302-9412
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1650-19
WI
Other
Enumeration date
07/03/2013
Last updated
07/03/2013
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