Provider Demographics
NPI:1316591555
Name:SUCHARSKI, JULIA MORGAN (PTA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MORGAN
Last Name:SUCHARSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BORREGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2105 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3133
Mailing Address - Country:US
Mailing Address - Phone:715-212-7627
Mailing Address - Fax:
Practice Address - Street 1:1445 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2011
Practice Address - Country:US
Practice Address - Phone:920-682-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2936225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant