Most Relevant Information
Provider Data
| NPI Number: | 1003439720 |
| Provider Name: | COURTNEY DISTERHAFT DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/28/2020 |
| Last Updated: | 05/28/2020 |
Provider Practice Location
225 MEMORIAL DR
BERLIN
WI
549231243
Practice Location Phone/Fax
| Phone: | 9203611313 |
| Fax: |
Provider Mailing Location
W13239 PENNY LN
RIPON
WI
549719586
Provider Mailing Phone/Fax
| Phone: | 9208961996 |
| Fax: |