Provider Demographics
NPI:1902632045
Name:ABOUELNAGA, NADA (DPT)
Entity type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:ABOUELNAGA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 147
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54005-8905
Mailing Address - Country:US
Mailing Address - Phone:715-263-4103
Mailing Address - Fax:715-263-4110
Practice Address - Street 1:930 ELDEN AVE
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1448
Practice Address - Country:US
Practice Address - Phone:715-268-5103
Practice Address - Fax:715-268-5101
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16983-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist