Provider Demographics
NPI:1710949235
Name:WANTA, MARGARET (PEG) A (PT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET (PEG)
Middle Name:A
Last Name:WANTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PEG
Other - Middle Name:A
Other - Last Name:WANTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:N91 W15750 FALL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-532-1100
Mailing Address - Fax:262-532-1409
Practice Address - Street 1:N91 W15750 FALL PARKWAY
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-532-1100
Practice Address - Fax:262-532-1409
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12189-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850395469OtherMUTUAL OF OMAHA
NM2010793355OtherPRESBYTERIAN HEALTHCARE
NMNM00Q500OtherBCBS PROVIDER #
NM850395469OtherTRICARE
NM850395469OtherTRICARE