Provider Demographics
NPI:1588847263
Name:WOMACK, HANNA MONICA (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:MONICA
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:MONICA
Other - Last Name:RONKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED PHYSICAL TH
Mailing Address - Street 1:316 NORTH MILWAUKEE STREET
Mailing Address - Street 2:SUITE 208 HERITAGE STAFFING CONSULTING
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5803
Mailing Address - Country:US
Mailing Address - Phone:414-615-0665
Mailing Address - Fax:414-615-0667
Practice Address - Street 1:316 NORTH MILWAUKEE STREET
Practice Address - Street 2:SUITE 208 HERITAGE STAFFING CONSULTING
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5803
Practice Address - Country:US
Practice Address - Phone:414-615-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI860019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant