Provider Demographics
NPI:1659887149
Name:MAI, ANNE LOUISE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:LOUISE
Last Name:MAI
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:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-0505
Mailing Address - Country:US
Mailing Address - Phone:715-617-6855
Mailing Address - Fax:
Practice Address - Street 1:1970 NAVAJO ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8890
Practice Address - Country:US
Practice Address - Phone:715-420-1593
Practice Address - Fax:715-362-0512
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant