Provider Demographics
NPI:1861654113
Name:PROSEN, BARBARA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:PROSEN
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:W237S7855 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9407
Mailing Address - Country:US
Mailing Address - Phone:262-662-2105
Mailing Address - Fax:
Practice Address - Street 1:W237S7855 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9407
Practice Address - Country:US
Practice Address - Phone:262-662-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI872019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40072500Medicaid