Provider Demographics
NPI:1841417938
Name:GRASSEL, PENNY K (LAT)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:K
Last Name:GRASSEL
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1729
Mailing Address - Country:US
Mailing Address - Phone:608-375-6050
Mailing Address - Fax:
Practice Address - Street 1:705 E TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-2110
Practice Address - Country:US
Practice Address - Phone:608-357-2216
Practice Address - Fax:608-357-2231
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer