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1184770711
BRIAN LEE ETHRIDGE
MADISON, WI
NPI
1184770711
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: WI 794-019)
Enumeration Date
2007-01-26
Last Update Date
2014-02-05
Business Address
-- BRIAN LEE ETHRIDGE pta
333 W MAIN ST
MADISON, WI 53703-2777
Phone number: 608-283-2123
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Mailing Address
-- BRIAN LEE ETHRIDGE pta
7704 WESTCHESTER DR
MIDDLETON, WI 53562-3600
Phone number: 608-445-3317
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