Provider Demographics
NPI:1649335712
Name:REWEY, LINDA JANE (PTA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JANE
Last Name:REWEY
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 1:3325 MOUND VIEW RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9743
Mailing Address - Country:US
Mailing Address - Phone:608-827-8834
Mailing Address - Fax:608-833-2026
Practice Address - Street 1:3325 MOUND VIEW RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9743
Practice Address - Country:US
Practice Address - Phone:608-827-8834
Practice Address - Fax:608-833-2026
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI254-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI254-019OtherPHYSICAL THERAPIST ASSITA