Tracy Bantleon

NPI #1811301591 in Sheboygan, Wisconsin

Provider Information

NPI Number: 1811301591
Entity Type: Individual
Name: Tracy Bantleon
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jun 20, 2014
Last Updated: Jun 20, 2014

Practice Location

Address: 3129 MICHIGAN AVE
City: Sheboygan
State: Wisconsin
ZIP Code: 53081-3062
Phone: (920) 458-1155

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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