Tanielle Summerill PTA
Physical Therapy Assistant in Wauwatosa, WI(View on Map)
Full Name
Tanielle Summerill PTA
NPI Number
1447351564
NPI Type
Individual Provider
Gender
Female
Enumeration Date
09/25/2006
Specialties
(Taxonomies)Licenses
State
Idaho
Wisconsin
License Number
PTA-300
990-019
Contact
Information
Purpose
Mailing
Location
Address
242 N 111TH ST
2626 N WAUWATOSA AVE
City
Wauwatosa
Wauwatosa
State
WI
WI
Postal Code
53226-4111
53213-1137
Country
US
US
Telephone Number
(414) 476-2304
(414) 774-7794
Identifiers
Identifier
40459000
Identifier State
WI
Identifier Issuer
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 07/08/2007
Provider Address
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