Provider Demographics
NPI:1285032664
Name:ANCLAM, ULMA (PTA)
Entity Type:Individual
Prefix:
First Name:ULMA
Middle Name:
Last Name:ANCLAM
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 1:13113 E CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53114-1127
Mailing Address - Country:US
Mailing Address - Phone:262-882-5481
Mailing Address - Fax:
Practice Address - Street 1:13113 E CREEK RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:WI
Practice Address - Zip Code:53114-1127
Practice Address - Country:US
Practice Address - Phone:262-882-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2233-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant