NPI 1023052099

Mark Allen Medina, PTA

Practitioner Physical Therapy Assistant Milwaukee, WI

Practice location

Address: 3471 S Kansas Ave, Milwaukee, WI 53207-3654
Phone: (414) 486-1307

Registered specialties

Physical Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225200000X Licence 0848-19 (WI)

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Registry record

NPI: 1023052099
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Jun 2006
Record last updated: 6 Nov 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.