Provider Demographics
NPI:1588818652
Name:POPP, PATRICIA (PTA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:POPP
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 1:116 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-9132
Mailing Address - Country:US
Mailing Address - Phone:715-299-1216
Mailing Address - Fax:
Practice Address - Street 1:116 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-9132
Practice Address - Country:US
Practice Address - Phone:715-299-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI793-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant