Provider Demographics
NPI:1912022286
Name:MEINERT, STELLA VIKTORIVNA (PTA)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:VIKTORIVNA
Last Name:MEINERT
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 1:1916 POLARIS AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2255
Mailing Address - Country:US
Mailing Address - Phone:262-619-9839
Mailing Address - Fax:
Practice Address - Street 1:3100 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1604
Practice Address - Country:US
Practice Address - Phone:262-658-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI491-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant