Provider Demographics
NPI:1831332246
Name:PAUC, JANICE ANGELROTH (PT)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ANGELROTH
Last Name:PAUC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:LYNN
Other - Last Name:ANGELROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:S83 W32580 MAGGI LANE
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149
Mailing Address - Country:US
Mailing Address - Phone:262-363-3321
Mailing Address - Fax:
Practice Address - Street 1:8802 W BECHER ST
Practice Address - Street 2:THERA DYNAMICS PHYSICAL THERAPY
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-541-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1420-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist