Provider Demographics
NPI:1881995116
Name:HOMONTOWSKI, GAIL M (PTA)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:HOMONTOWSKI
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 1:3744 S CHEROKEE WAY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5753
Mailing Address - Country:US
Mailing Address - Phone:414-615-0665
Mailing Address - Fax:
Practice Address - Street 1:3744 S CHEROKEE WAY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5753
Practice Address - Country:US
Practice Address - Phone:414-615-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1546-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant