Provider Demographics
NPI:1790949022
Name:READY, TINA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:READY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:VANDER LOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:N4231 HWY 22 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166
Mailing Address - Country:US
Mailing Address - Phone:715-526-3158
Mailing Address - Fax:715-526-6225
Practice Address - Street 1:N 4231 HWY 22 SOUTH
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-4166
Practice Address - Country:US
Practice Address - Phone:715-526-3158
Practice Address - Fax:715-526-6225
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40237400Medicaid