Provider Demographics
NPI:1376874123
Name:UETZ, LYNDSEY
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:UETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 17TH AVE
Mailing Address - Street 2:PO BOX 176
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 BREMER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:COLFAX
Practice Address - State:WI
Practice Address - Zip Code:54730-8930
Practice Address - Country:US
Practice Address - Phone:715-962-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1603-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376874123Medicaid