Provider Demographics
NPI:1114740420
Name:GOLAT-HATTANER, ALLISON MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MICHELLE
Last Name:GOLAT-HATTANER
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 1:30446 COUNTY HWY W
Mailing Address - Street 2:
Mailing Address - City:HOLCOMBE
Mailing Address - State:WI
Mailing Address - Zip Code:54745-4547
Mailing Address - Country:US
Mailing Address - Phone:715-827-0221
Mailing Address - Fax:
Practice Address - Street 1:206 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:THORP
Practice Address - State:WI
Practice Address - Zip Code:54771-9303
Practice Address - Country:US
Practice Address - Phone:715-827-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4218-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant