Provider Demographics
NPI:1073029260
Name:LAPHAM, DEANNA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:LAPHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12284 COUNTY 17
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55921-4720
Mailing Address - Country:US
Mailing Address - Phone:507-459-5443
Mailing Address - Fax:
Practice Address - Street 1:2448 S 102ND ST STE 340
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-2147
Practice Address - Country:US
Practice Address - Phone:414-329-2500
Practice Address - Fax:414-329-2501
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2011225200000X
WI2305-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant