Gustafson, Eva Marie

Gustafson, Eva Marie is an sole proprietor health care provider with primary practice located at 7830 State Highway 13 , Port Wing WI 54865-4721. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Gustafson, Eva Marie can be contacted via phone (715) 774-3195.

Contact Information

Primary practice address
7830 State Highway 13 Port Wing WI 54865-4721
Phone: (715) 774-3195
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 4231-024 Wisconsin

Profile Details

NPI number 1730352758
LBN Legal business name Gustafson, Eva Marie
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 10th, 2008
Last updated Apr 10th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730352758 NPPES
Wisconsin MEDICAID 40163400

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