Provider Demographics
NPI:1922043868
Name:ONTL, NANCY L (PHYSICIAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:ONTL
Suffix:
Gender:F
Credentials:PHYSICIAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 24TH ST S
Mailing Address - Street 2:PO BOX 8005
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-8005
Mailing Address - Country:US
Mailing Address - Phone:715-424-1881
Mailing Address - Fax:715-423-1602
Practice Address - Street 1:140 24TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-1906
Practice Address - Country:US
Practice Address - Phone:715-424-1881
Practice Address - Fax:715-423-1602
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5837-0242251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40380800Medicaid
WI72080 0004Medicare PIN
WI40380800Medicaid