Provider Demographics
NPI:1629813225
Name:FASHINGBAUER, LUCY
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:FASHINGBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 PRIESTER LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7531
Mailing Address - Country:US
Mailing Address - Phone:715-441-7757
Mailing Address - Fax:
Practice Address - Street 1:916 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8280
Practice Address - Country:US
Practice Address - Phone:715-716-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16799242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic