Provider Demographics
NPI:1962739441
Name:STOUT, PAULA ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:ANN
Last Name:STOUT
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 1:1130 N. MARGARET ST.
Mailing Address - Street 2:MARKESAN RESIDENT HOME
Mailing Address - City:MARKESAN
Mailing Address - State:WI
Mailing Address - Zip Code:53946
Mailing Address - Country:US
Mailing Address - Phone:920-398-2751
Mailing Address - Fax:920-398-3937
Practice Address - Street 1:1130 N. MARGARET ST.
Practice Address - Street 2:MARKESAN RESIDENT HOME
Practice Address - City:MARKESAN
Practice Address - State:WI
Practice Address - Zip Code:53946
Practice Address - Country:US
Practice Address - Phone:920-398-2751
Practice Address - Fax:920-398-3937
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1581-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant