Provider Demographics
NPI:1851070551
Name:SALMON, GWENDELIN ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GWENDELIN
Middle Name:ANN
Last Name:SALMON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 FREELAND CT
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1658
Mailing Address - Country:US
Mailing Address - Phone:414-210-0088
Mailing Address - Fax:414-344-8245
Practice Address - Street 1:7711 FREELAND CT
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1658
Practice Address - Country:US
Practice Address - Phone:414-210-0088
Practice Address - Fax:414-344-8245
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16332-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist