Provider Demographics
NPI:1275610180
Name:TRIMBERGER-HENDRICKSON, MIKEALYNN M (PTA)
Entity Type:Individual
Prefix:
First Name:MIKEALYNN
Middle Name:M
Last Name:TRIMBERGER-HENDRICKSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MIKEALYNN
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:N8573 LITTLE ELKHART LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELKHART LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53020-1669
Mailing Address - Country:US
Mailing Address - Phone:920-980-4976
Mailing Address - Fax:
Practice Address - Street 1:1001 SERVICE RD
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1297
Practice Address - Country:US
Practice Address - Phone:920-894-2636
Practice Address - Fax:920-894-2636
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI262-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant