Most Relevant Information
Provider Data
| NPI Number: | 1003535071 |
| Provider Name: | MAGNOLIA MAE GRENAWALT PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 208100000X |
| Specialty: | Physical Medicine & Rehabilitation |
| License Number: | 4002-19 |
Most Important Dates
| Enumeration Date: | 08/24/2022 |
| Last Updated: | 08/24/2022 |
Provider Practice Location
600 2ND AVE
NEW GLARUS
WI
535749776
Practice Location Phone/Fax
| Phone: | 6085274390 |
| Fax: |
Provider Mailing Location
600 2ND AVE
NEW GLARUS
WI
535749776
Provider Mailing Phone/Fax
| Phone: | 6085274390 |
| Fax: |