Provider Demographics
NPI:1396934634
Name:MARTEL-ARQUETTE, ANNA KRISTIN (PT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KRISTIN
Last Name:MARTEL-ARQUETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1506 S. ONEIDA ST.
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-738-2831
Mailing Address - Fax:920-738-2818
Practice Address - Street 1:1506 S. ONEIDA ST.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915
Practice Address - Country:US
Practice Address - Phone:920-738-2831
Practice Address - Fax:920-738-2818
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1633-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40361600Medicaid